体重指数对多发性骨髓瘤退伍军人生存的影响。
Influence of body mass index on survival in veterans with multiple myeloma.
机构信息
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA;
出版信息
Oncologist. 2013;18(10):1074-9. doi: 10.1634/theoncologist.2013-0015. Epub 2013 Sep 18.
PURPOSE
We investigated the association between body mass index (BMI) at the time of multiple myeloma (MM) diagnosis and overall survival in a cohort of patients within the Veterans Health Administration system. We also evaluated the association between weight loss in the year prior to diagnosis and survival.
PATIENTS AND METHODS
Prospective analysis was performed on a retrospectively assembled cohort of 2,968 U.S. veterans diagnosed and treated for MM between September 1, 1999, and September 30, 2009, with follow-up information through October 22, 2011. Cox modeling controlling for patient- and disease-related prognostic variables was used to analyze the data.
RESULTS
Underweight patients (BMI <18.5 kg/m2) had increased mortality, whereas patients who were overweight (BMI 25-29.9 kg/m2) and obese (BMI ≥30 kg/m2) had lower mortality compared with healthy-weight patients (BMI 18.5-24.9 kg/m2). Weight loss ≥10% of baseline in the year before diagnosis was also associated with increased mortality and made the association between increased BMI and survival nonsignificant.
CONCLUSION
Disease-related weight loss may be an important and heretofore unknown indicator of poor prognosis in MM. Assessment of weight loss prior to MM diagnosis should become a standard component of the clinical history in patients with newly diagnosed MM. Further research may identify relationships between disease-related weight loss and currently used prognostic factors in MM, further defining the role of this clinical factor in prognostic stratification.
目的
我们研究了退伍军人健康管理系统中一组多发性骨髓瘤（MM）患者在诊断时的体重指数（BMI）与总生存之间的关系。我们还评估了诊断前一年内体重减轻与生存之间的关系。
方法
对 1999 年 9 月 1 日至 2009 年 9 月 30 日期间接受 MM 诊断和治疗的 2968 名美国退伍军人进行回顾性队列分析，随访信息截至 2011 年 10 月 22 日。使用 Cox 模型控制患者和疾病相关预后变量来分析数据。
结果
体重不足患者（BMI<18.5 kg/m2）死亡率增加，而超重患者（BMI 25-29.9 kg/m2）和肥胖患者（BMI≥30 kg/m2）死亡率低于体重正常患者（BMI 18.5-24.9 kg/m2）。诊断前一年内体重减轻≥10%基线也与死亡率增加相关，并使 BMI 增加与生存之间的关系变得不显著。
结论
与疾病相关的体重减轻可能是 MM 预后不良的一个重要且未知的指标。在诊断 MM 之前评估体重减轻应成为新诊断 MM 患者临床病史的标准组成部分。进一步的研究可能会确定与疾病相关的体重减轻与 MM 中目前使用的预后因素之间的关系，从而进一步确定这一临床因素在预后分层中的作用。
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