Sun Qian, Cui Jialin, Liu Wenjie, Li Jianyong, Hong Ming, Qian Sixuan
Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.
Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China.
Front Oncol. 2022 Feb 10;12:828939. doi: 10.3389/fonc.2022.828939. eCollection 2022.
Acute myeloid leukemia (AML) occurs frequently in the elderly, of whom the prognosis is dismal. Sarcopenia is a progressive and generalized skeletal muscle disorder associated with an increased possibility of adverse outcomes. This study aims to explore the prognostic value of sarcopenia in AML patients and develop a novel prognostic model.
A total of 227 AML patients were enrolled. Body composition was assessed by bioelectrical impedance analysis before treatment. Sarcopenia was diagnosed by low muscle quantity. Cox proportional hazard regression model were applied to verify prognostic variables for overall survival (OS) and disease-free survival (DFS). A novel prognostic model of nomogram was developed and validated by 'R'.
Forty-one (18.1%) patients were defined as sarcopenia. The median age of the sarcopenic group was significantly greater than the non-sarcopenic group (median 70 vs. 64 years, = 0.001). Sarcopenic patients showed significantly less height ( = 0.002), weight (0.001), Body Mass Index (0.001), Fat Mass ( = 0.017), Fat-free Mass (0.001), Appendicular Skeletal Muscle Mass (0.001), Skeletal Muscle Index (0.001), Fat-free Mass Index (0.001), and hemoglobin level ( = 0.025) than the non-sarcopenic ones. Patients in the sarcopenic group also showed a statistically shorter OS and DFS (median OS: 13.7 vs. 55.6 months, = 0.003; median DFS: 12.5 months vs. not reached, = 0.026). ELN high risk [Hazard Ratio (HR): 1.904, 95% Confidence Interval (CI): 1.018-3.562, = 0.044), sarcopenia (HR: 1.887, 95% CI: 1.071-3.324, = 0.028), and reduced-intensity regimens (HR: 3.765, 95% CI: 1.092-12.980, = 0.036) were independent predictors for OS in multivariate analysis. A nomogram for predicting OS was constructed using the above three factors. The index, calibration plots and decision curve analyses (DCA) showed better discrimination, calibration, and net benefits of the nomogram than the ELN model.
Sarcopenia was common and had an inferior prognosis in AML and needs more attention in clinical practice.
急性髓系白血病（AML）在老年人中频繁发生，其预后不佳。肌肉减少症是一种进行性全身性骨骼肌疾病，与不良结局可能性增加相关。本研究旨在探讨肌肉减少症在AML患者中的预后价值，并建立一种新的预后模型。
共纳入227例AML患者。治疗前通过生物电阻抗分析评估身体成分。通过低肌肉量诊断肌肉减少症。应用Cox比例风险回归模型验证总生存期（OS）和无病生存期（DFS）的预后变量。通过“R”开发并验证了一种新的列线图预后模型。
41例（18.1%）患者被定义为肌肉减少症。肌肉减少症组的中位年龄显著高于非肌肉减少症组（中位年龄70岁对64岁，P = 0.001）。肌肉减少症患者的身高（P = 0.002）、体重（P = 0.001）、体重指数（P = 0.001）、脂肪量（P = 0.017）、去脂体重（P = 0.001）、四肢骨骼肌量（P = 0.001）、骨骼肌指数（P = 0.001）、去脂体重指数（P = 0.001）和血红蛋白水平（P = 0.025）均显著低于非肌肉减少症患者。肌肉减少症组患者的OS和DFS在统计学上也较短（中位OS：13.7个月对55.6个月，P = 0.003；中位DFS：12.5个月对未达到，P = 0.026）。欧洲白血病网络（ELN）高危[风险比（HR）：1.904，95%置信区间（CI）：1.018 - 3.562，P = 0.044]、肌肉减少症（HR：1.887，95%CI：1.071 - 3.324，P = 0.028）和减低强度方案（HR：3.765，95%CI：1.092 - 12.980，P = 0.036）在多因素分析中是OS的独立预测因素。使用上述三个因素构建了预测OS的列线图。一致性指数、校准曲线和决策曲线分析（DCA）显示，列线图比ELN模型具有更好的区分度、校准度和净效益。
肌肉减少症在AML中常见且预后较差，在临床实践中需要更多关注。
