Objective Patients with acute myeloid leukemia(AML)may experience physicalcomposition changes as a result of chemotherapy.However,it is unclear if these physical composition changes will affect the survival outcome or not.This study aims to assess the predictive value of abnormal quantitative CT(QCT)bodycompositionmetricsafter chemothera-py onpredicting survival outcomes in AML patients.Methods The clinical factors and evolution of QCT metrics of 114 AML patients pre-and post-chemotherapy were analyzed retrospectively.Based on the median overall survival(OS),these AML patients were assigned into favorable and poor outcome groups.We compared the clinical factors and QCT metrics be-tween the two groups.Multivariate Cox analysis was used to identify the independent risk factors which associated with the poor outcome.Receiver operating characteristic curve(ROC)was employed to evaluate the diagnostic performances of the clinical,QCT,and combination models in assessing poor survival outcome of AML patients.Results Compared to patients with favorable survival outcome,the patients with poor outcome were elder(P=0.022),higher risk stratification(P=0.002),more positive minimal residual lesion(MRD)(P=0.017),higher incidence of sarcopenia(P=0.001),higher incidence of decrease of subcutaneous adipose(SAT)(P=0.001)and visceral adipose(VAT)(P=0.014).Multivari-ate analysis showed that elder(P=0.025),higher risk stratification(P=0.003),positive MRD(P=0.001),sarcopenia(P=0.044),decrease of SAT(P＜0.001)and VAT(P=0.035)were the independent risk factors of poor OS.The AUC values(AUCs)of clinical,imaging,and combination models in predicting poor OS of AML patients were 0.786,0.697,and 0.810,respectively.Delong test showed that there was significant difference among the AUCs of these models(P=0.026)in predicting poor OS.The AUCs of clinical,imaging,and combination models in predicting disease-free survival(DFS)were 0.763,0.664,and 0.785,respectively.However,there was only significant difference of AUCs between imaging and combination models(P=0.041)in predicting DFS.Conclusion As feasible tools,the QCT metrics,including sarcopenia and decrease of SAT and VAT,could improve the diagnostic performances of the combination model in evaluating the surviv-al outcome in AML patients after chemotherapy.It is suggested that the QCT analysis should be carried out routinely in pa-tients with AML after chemotherapy.
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