Morphometrics predicts overall survival in patients with multiple myeloma spine metastasis: A retrospective cohort study.
Morphometrics predicts overall survival in patients with multiple myeloma spine metastasis: A retrospective cohort study.
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DOI：
10.4103/sni.sni_383_17
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发表时间：
2018
影响因子：
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通讯作者：
Chang V
中科院分区：
文献类型：
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作者：
Zakaria HM;Elibe E;Macki M;Smith R;Boyce-Fappiano D;Lee I;Griffith B;Siddiqui F;Chang V
骨髓瘤脊柱转移的治疗策略从保守措施(放疗和化疗)到侵入性措施(手术)。确定更好的总生存期(OS)预测因素将有助于手术决策。分析形态计量学已被证明可以预测肿瘤患者的生存，我们的研究评估了形态计量学是否可以预测多发性骨髓瘤(MM)脊柱转移患者的生存。在这项观察性的回顾性队列研究中，我们确定了46名接受过立体定向全身放射治疗的多发性骨髓瘤脊柱转移患者。OS是主要的结果衡量标准。腰大肌的形态计量分析是使用腰椎的计算机断层扫描进行的。OS与年龄(P=0.025)、肿瘤负荷(P=0.023)和照射次数(P=0.029)有统计学意义的相关性，但与性别无关。腰大肌平均大小最低三分位数的患者生存时间明显短于腰大肌平均大小三分位数最高的三分位数的患者，风险比(HZ)为6.87(95%CI=1.65~28.5，P=0.008)。在计算腰大肌大小与椎体大小的比值并将其与OS相关时，最低三分位数与最高三分位数相比，OS也显著缩短(95%CI=1.57~29.89，P=0.010)；中三分位数较高三分位数显著缩短(95%CI=1.34~19.10，P=0.016)。采用Kaplan-Meier生存曲线直观地说明不同类型患者的生存差异(Log-ranch检验，P=0.006)。形态计量学分析成功地预测了MM患者的长期存活。还需要更多的研究来验证这些结果，并看看这些方法是否可以应用于其他癌症组织学。
Treatment strategies for spinal metastases for myeloma range from conservative measures (radiation and chemotherapy) to invasive (surgical). Identifying better predictors of overall survival (OS) would help in surgical decision making. Analytic morphometrics has been shown to predict survival in oncologic patients, and our study evaluates whether morphometrics is predictive of survival in patients with multiple myeloma (MM) spinal metastases. For this observational retrospective cohort study, we identified 46 patients with MM spinal metastases who had undergone stereotactic body radiation therapy. OS was the primary outcome measure. Morphometric analysis of the psoas muscle was performed using computed tomography scans of the lumbar spine. OS was statistically correlated with age (P = 0.025), tumor burden (P = 0.023), and number of levels radiated (P = 0.029), but not with gender. Patients in the lowest tertile of average psoas size had significantly shorter survival compared to the highest tertile, hazard ratio (HZ) 6.87 (95% CI = 1.65–28.5, P = 0.008). When calculating the psoas size to vertebral body ratio and correlating this measure to OS, the lowest tertile again had significantly shorter OS compared to the highest tertile, HZ 6.87 (95% CI = 1.57–29.89, P = 0.010); the middle tertile also showed significantly shorter OS compared to the highest tertile, HZ 5.07 (95% CI = 1.34–19.10, P = 0.016). Kaplan–Meier survival curves were used to visually illustrate the differences in survival between different tertiles (Log-rank test P = 0.006). Morphometric analysis successfully predicts long-term survival in patients with MM. More research is needed to validate these results and to see if these methodologies can be applied to other cancer histologies.