Rades Dirk, Conde-Moreno Antonio Jose, Cacicedo Jon, Veninga Theo, Gebauer Niklas, Bartscht Tobias, Schild Steven E
Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, D-23538, Lubeck, Germany.
Department of Radiation Oncology, Consorcio Hospital Provincial de Castellón, Castellón, Spain.
BMC Cancer. 2016 Apr 25;16:292. doi: 10.1186/s12885-016-2325-y.
This study was performed to design a predictive tool that allows the estimation of overall survival (OS) of elderly myeloma patients (aged ≥ 65 years) presenting with myeloma-induced spinal cord compression (SCC).
One-hundred-and-sixteen patients irradiated for motor deficits of the legs due to myeloma-induced spinal cord compression were retrospectively evaluated. Ten characteristics were analyzed for OS including age, interval between myeloma diagnosis and radiotherapy, other osseous myeloma lesions, myeloma type, gender, time developing motor deficits, number of affected vertebrae, ECOG-PS, pre-radiotherapy ambulatory status, and fractionation regimen. Characteristics that achieved significance on multivariate analysis were included in the predictive tool. The score for each characteristic was obtained from the 1-year OS rate divided by 10. The sum of these scores represented the prognostic score for each patient.
On multivariate analysis, myeloma type (hazard ratio 3.31; 95%-confidence interval 1.75-6.49; p < 0.001), ECOG-PS (HR 5.33; 95%-CI 2.67-11.11; p < 0.001), ambulatory status (HR 2.71; 95% CI 1.65-4.57; p < 0.001), and age (HR 1.95; 95% CI 1.03-3.78; p = 0.040) were significantly associated with survival. Sum scores ranged from 18 to 32 points. Based on the sum scores, three prognostic groups were designed: 18-19, 21-28 and 29-32 points. The corresponding 1-year survival rates were 0, 43 and 96%, respectively (p < 0.001).
This new predictive tool has been specifically designed for elderly myeloma patients with SCC. It allows estimating the survival prognosis of this patient group and supports the treating physicians when looking for the optimal treatment approach for an individual patient.
本研究旨在设计一种预测工具，用于估计患有骨髓瘤诱导的脊髓压迫（SCC）的老年骨髓瘤患者（年龄≥65岁）的总生存期（OS）。
回顾性评估了116例因骨髓瘤诱导的脊髓压迫导致腿部运动功能障碍而接受放疗的患者。分析了与总生存期相关的10个特征，包括年龄、骨髓瘤诊断与放疗之间的间隔、其他骨髓瘤骨病变、骨髓瘤类型、性别、出现运动功能障碍的时间、受累椎体数量、东部肿瘤协作组体能状态（ECOG-PS）、放疗前的行走状态以及分割方案。多因素分析中有显著意义的特征被纳入预测工具。每个特征的分数通过1年总生存率除以10得到。这些分数的总和代表每个患者的预后分数。
多因素分析显示，骨髓瘤类型（风险比3.31；95%置信区间1.75 - 6.49；p < 0.001）、ECOG-PS（HR 5.33；95%CI 2.67 - 11.11；p < 0.001）、行走状态（HR 2.71；95%CI 1.65 - 4.57；p < 0.001）和年龄（HR 1.95；95%CI 1.03 - 3.78；p = 0.040）与生存显著相关。总分范围为18至32分。根据总分设计了三个预后组：18 - 19分、21 - 28分和29 - 32分。相应的1年生存率分别为0%、43%和96%（p < 0.001）。
这种新的预测工具是专门为患有SCC的老年骨髓瘤患者设计的。它可以估计该患者群体的生存预后，并在为个体患者寻找最佳治疗方法时为治疗医生提供支持。
