The value of gender -specific baseline CT body composition quantitative parameters in assessing the efficacy of R-CHOP chemotherapy in DLBCL

To investigate the value of sex differences in baseline CT-derived body composition parameters for predicting the interim efficacy of the R-CHOP regimen in DLBCL patients. We retrospectively included DLBCL patients who received R-CHOP and pre-treatment CT (January 2015–August 2023). Gender-stratified analysis compared L1-L5 visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle (SM) volumes, alongside L3 area measurements. Multivariate logistic regression identified sex-specific predictors of poor efficacy, visualized using nomograms. A total of 169 patients were divided into remission (n = 129) and non-remission (n = 40) groups. In males, VAT volume (p = 0.004) and SAT volume density (p = 0.002) were independent risk factors for poor efficacy, while SM volume (p = 0.023) was the key risk factor for females. Gender-specific nomograms were developed for outcome predictionand were then utilized to achieve accurate prediction of treatment outcomes for four patients with varying body composition. No significant association was found between body composition areas and Chemotherapy efficiency (p > 0.05). Increased VAT volume and SAT volume density are linked to poor efficiency in male DLBCL patients, while increased SM volume relates to poor outcomes in females. Sex differences in body composition play a crucial role in personalized DLBCL treatment.