Associations of Subcutaneous and Visceral Fat Areas with Progression-Free Survival in Patients with Diffuse Large B-Cell Lymphoma.
8 affiliations
- 1Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan.
- 2Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- 3Center for Big Data Research, Kaohsiung Medical University 807, Kaohsiung, Taiwan.
- 4Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung 804, Taiwan.
- 5Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- 6Department of Occupational Safety and Health, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- 7Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- 8Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
Abstract
Background
Body composition, particularly adipose tissue distribution, may modulate cancer progression and therapeutic outcomes. This study investigated the associations of subcutaneous fat area (SFA) and visceral fat area (VFA) with progression-free survival (PFS) in patients with diffuse large B-cell lymphoma (DLBCL).Methods
This retrospective study included 110 patients with DLBCL diagnosed between 2010 and 2019. SFA and VFA were quantified from baseline computed tomography images using a previously validated automated deep learning-based segmentation system and analyzed as continuous variables standardized to 1-standard deviation (SD) increments. Associations with PFS were evaluated using Cox proportional hazards regression adjusted for the International Prognostic Index (IPI), with joint modeling, sensitivity analyses, restricted cubic spline analysis, and bootstrap internal validation. Overall survival (OS) was additionally evaluated in exploratory analyses.Results
During a mean follow-up of 63.5 ± 45.2 months, 46 PFS events (41.8%) were observed. In separate IPI-adjusted models, each 1-SD increase in SFA was associated with poorer PFS (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.00-1.79; p = 0.047), whereas VFA was not significantly associated with PFS (HR, 1.09; 95% CI, 0.82-1.44; p = 0.552). In the joint model, the SFA estimate remained similar (HR, 1.33; 95% CI, 0.99-1.79; p = 0.057), whereas the VFA estimate remained close to the null (HR, 1.03; 95% CI, 0.76-1.38; p = 0.868); the standardized coefficients did not differ significantly (p = 0.265). Adding SFA to the IPI yielded a small increase in the apparent C-index (0.618 to 0.632; ΔC-index, 0.014; bootstrap 95% CI, -0.013 to 0.069). In exploratory analyses, neither SFA nor VFA was significantly associated with OS.Conclusion
Higher SFA was associated with poorer PFS after adjustment for the IPI, whereas VFA showed little evidence of an association; however, the difference between their associations was not statistically significant, and neither adipose tissue compartment was significantly associated with OS. The incremental prognostic value of SFA beyond the IPI was limited. Larger studies with external validation are needed to confirm these findings.
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BibTeX
@article{geng2026associations,
title = {{Associations of Subcutaneous and Visceral Fat Areas with Progression-Free Survival in Patients with Diffuse Large B-Cell Lymphoma.}},
author = {Jiun-Hung Geng and Chien-Hsiang Chang and Yi-Chang Liu and Hui-Hua Hsiao and Tsung-Jang Yeh and Jeng-Shiun Du and Min-Hong Wang and Yu-Yin Lin and Wen-Hsin Chang and Chin-Mu Hsu and Chun-Hung Richard Lin and Shih-Feng Cho},
journal = {International journal of medical sciences},
year = {2026},
month = sep,
doi = {10.7150/ijms.137961},
url = {https://europepmc.org/article/MED/42910135},
note = {CC BY},
}
RIS
TY - JOUR
TI - Associations of Subcutaneous and Visceral Fat Areas with Progression-Free Survival in Patients with Diffuse Large B-Cell Lymphoma.
AU - Jiun-Hung Geng
AU - Chien-Hsiang Chang
AU - Yi-Chang Liu
AU - Hui-Hua Hsiao
AU - Tsung-Jang Yeh
AU - Jeng-Shiun Du
AU - Min-Hong Wang
AU - Yu-Yin Lin
AU - Wen-Hsin Chang
AU - Chin-Mu Hsu
AU - Chun-Hung Richard Lin
AU - Shih-Feng Cho
PY - 2026
DA - 2026/09/24
JO - International journal of medical sciences
DO - 10.7150/ijms.137961
UR - https://europepmc.org/article/MED/42910135
AB - Background Body composition, particularly adipose tissue distribution, may modulate cancer progression and therapeutic outcomes. This study investigated the associations of subcutaneous fat area (SFA) and visceral fat area (VFA) with progression-free survival (PFS) in patients with diffuse large B-cell lymphoma (DLBCL).Methods This retrospective study included 110 patients with DLBCL diagnosed between 2010 and 2019. SFA and VFA were quantified from baseline computed tomography images using a previously validated automated deep learning-based segmentation system and analyzed as continuous variables standardized to 1-standard deviation (SD) increments. Associations with PFS were evaluated using Cox proportional hazards regression adjusted for the International Prognostic Index (IPI), with joint modeling, sensitivity analyses, restricted cubic spline analysis, and bootstrap internal validation. Overall survival (OS) was additionally evaluated in exploratory analyses.Results During a mean follow-up of 63.5 ± 45.2 months, 46 PFS events (41.8%) were observed. In separate IPI-adjusted models, each 1-SD increase in SFA was associated with poorer PFS (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.00-1.79; p = 0.047), whereas VFA was not significantly associated with PFS (HR, 1.09; 95% CI, 0.82-1.44; p = 0.552). In the joint model, the SFA estimate remained similar (HR, 1.33; 95% CI, 0.99-1.79; p = 0.057), whereas the VFA estimate remained close to the null (HR, 1.03; 95% CI, 0.76-1.38; p = 0.868); the standardized coefficients did not differ significantly (p = 0.265). Adding SFA to the IPI yielded a small increase in the apparent C-index (0.618 to 0.632; ΔC-index, 0.014; bootstrap 95% CI, -0.013 to 0.069). In exploratory analyses, neither SFA nor VFA was significantly associated with OS.Conclusion Higher SFA was associated with poorer PFS after adjustment for the IPI, whereas VFA showed little evidence of an association; however, the difference between their associations was not statistically significant, and neither adipose tissue compartment was significantly associated with OS. The incremental prognostic value of SFA beyond the IPI was limited. Larger studies with external validation are needed to confirm these findings.
SN - 1449-1907
ER -