Wirk Baldeep, Bush Charles H, Hou Wei, Pettiford Leslie, Moreb Jan S
Department of Medicine, College of Medicine, University of Florida, USA.
Department of Radiology, College of Medicine, University of Florida, USA.
World J Oncol. 2012 Aug;3(4):147-157. doi: 10.4021/wjon551w. Epub 2012 Aug 26.
Multiple myeloma (MM), a plasma cell malignancy, is the most common cancer to involve the skeleton. Skeletal related events such as pathologic fractures and lytic bone lesions have been associated with poor prognosis. Whole body multidetector computed tomography (WBCT) has been shown to be the most sensitive imaging modality in detecting small osteolytic lesions (< 5 mm) in the spine. The significance of lytic lesions detected only by CT is unknown as is their impact on overall survival of MM. The aim of this study was to evaluate the impact of lytic bone lesions seen only by WBCT on progression free survival (PFS) and overall survival (OS) in MM patients after hematopoietic cell transplantation (HCT).
We evaluated 72 patients who had WBCT and conventional radiographic skeletal survey (CSS) after initial or salvage chemotherapy prior to HCT.
Forty-one patients (57%) had more findings on WBCT than CSS, 31 patients (43%) had no differences in the two imaging techniques, 9 patients had no bone lesions on either modality, and 5 patients had lesions only identified by WBCT and not on CSS. PFS and OS were similar in patients with lesions seen by CSS irrespective of whether additional lesions were noted by WBCT; similarly, in patients without lesions on CSS, OS and PFS were better than patients with lytic lesions, but detection of occult lesions by WBCT did not adversely affect PFS or OS.
Our study shows that although WBCT is more sensitive in defining existing myelomatous bony disease in MM, these additional findings may not have any impact on PFS and OS of MM patients. Only patients without any bone lesions on conventional skeletal survey had significantly better PFS and OS. This suggests CSS remains the gold standard for evaluating myeloma bone disease.
多发性骨髓瘤（MM）是一种浆细胞恶性肿瘤，是最常见的累及骨骼的癌症。骨骼相关事件，如病理性骨折和溶骨性骨病变，与预后不良相关。全身多排螺旋计算机断层扫描（WBCT）已被证明是检测脊柱中小的溶骨性病变（<5mm）最敏感的成像方式。仅通过CT检测到的溶骨性病变的意义及其对MM患者总生存期的影响尚不清楚。本研究的目的是评估仅通过WBCT发现的溶骨性骨病变对造血细胞移植（HCT）后MM患者无进展生存期（PFS）和总生存期（OS）的影响。
我们评估了72例在HCT前接受初始或挽救性化疗后进行了WBCT和传统X线骨骼检查（CSS）的患者。
41例患者（57%）WBCT检查发现的病变比CSS更多，31例患者（43%）两种成像技术检查结果无差异，9例患者两种检查方式均未发现骨病变，5例患者仅通过WBCT发现病变而CSS未发现。CSS检查发现有病变的患者，无论WBCT是否发现额外病变，其PFS和OS相似；同样，CSS检查未发现病变的患者，其OS和PFS优于有溶骨性病变的患者，但WBCT检测到隐匿性病变并未对PFS或OS产生不利影响。
我们的研究表明，尽管WBCT在定义MM现有的骨髓瘤骨病方面更敏感，但这些额外发现可能对MM患者的PFS和OS没有任何影响。只有在传统骨骼检查中没有任何骨病变的患者，其PFS和OS明显更好。这表明CSS仍然是评估骨髓瘤骨病的金标准。
