Temporalis muscle thickness predicts early relapse and short survival in primary CNS lymphoma

Alipi V Bonm; Anthony Menghini; Caroline E Drolet; Jerome J Graber

doi:10.1093/nop/npac087

Temporalis muscle thickness predicts early relapse and short survival in primary CNS lymphoma

Neurooncol Pract. 2022 Oct 22;10(2):162-168. doi: 10.1093/nop/npac087. eCollection 2023 Apr.

Authors

Alipi V Bonm¹, Anthony Menghini², Caroline E Drolet³, Jerome J Graber⁴

Affiliations

¹ Department of Neurology, Virginia Mason Franciscan Health, Seattle, Washington, USA.
² School of Medicine, University of Washington, Seattle, Washington, USA.
³ Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, Washington, USA.
⁴ Departments of Neurology and Neurosurgery, Alvord Brain Tumor Center, University of Washington, Seattle, Washington, USA.

Abstract

Background: Most patients with primary CNS lymphoma (PCNSL) achieve durable remission whereas a minority die in the first year. Sarcopenia is a powerful predictor of mortality in the brain and systemic cancers. Temporalis muscle thickness (TMT) is a validated radiographic measure of sarcopenia. We hypothesized that patients with thin TMT at diagnosis would have early progression and short survival.

Methods: Two blinded operators retrospectively measured TMT in 99 consecutive brain MRIs from untreated patients with PCNSL.

Results: We generated a receiver operator characteristic curve and chose a single threshold defining thin TMT in all patients as <5.65 mm, at which specificity and sensitivity for 1-year progression were 98.4% and 29.7% and for 1-year mortality were 97.4% and 43.5% respectively. Those with thin TMT were both more likely to progress (P < .001) and had higher rates of mortality (P < .001). These effects were independent of the effect of age, sex, and Eastern Cooperative Oncology Group performance status in a cox regression. Memorial Sloan Kettering Cancer Center score did not predict progression-free survival or overall survival as well as TMT. Patients with thin TMT received fewer cycles of high-dose methotrexate and were less likely to receive consolidation but neither variable could be included in the Cox regression due to violation of the proportional hazards assumption.

Conclusions: We conclude that PCNSL patients with thin TMT are at high risk for early relapse and short survival. Future trials should stratify patients by TMT to avoid confounding.

Keywords: CNS lymphoma; sarcopenia; temporalis muscle thickness.

© The Author(s) 2022. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.