Diallo Thierno D, Blessing Ariane Irma Luise, Ihorst Gabriele, Möller Mandy Deborah, Jungmann Pia M, Bamberg Fabian, Herget Georg, Wäsch Ralph, Engelhardt Monika, Neubauer Jakob
Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
Clinical Trials Unit, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Skeletal Radiol. 2025 Feb;54(2):275-285. doi: 10.1007/s00256-024-04735-y. Epub 2024 Jun 28.
Fatty infiltration of skeletal muscle (Myosteatosis) is associated with increased frailty, decreased muscle and mobility function, which seems fairly prevalent in multiple myeloma (MM) patients. This study aimed to determine the prognostic value of myosteatosis assessed by CT for progression-free survival (PFS) and overall survival (OS).
This IRB-approved cohort study included patients with newly diagnosed MM who were treated at a single university hospital and received CT at baseline. Geriatric assessment was performed via International Myeloma Working Group frailty score and Revised Myeloma Comorbidity Index. Myosteatosis was determined through measurement of paravertebral muscle radiodensity. Statistical analyses included uni- and multivariable Cox proportional hazard models and the Kaplan-Meier-method.
A total of 226 newly diagnosed MM patients (median age: 65 years [range: 29-89], 63% males, mean BMI: 25 [14-42]) were analyzed. The prevalence of myosteatosis was 51%. Muscle radiodensity was significantly decreased in individuals with International Staging System stage III vs. I (p < 0.001), indicating higher fatty muscle infiltration in patients with advanced disease. Both PFS and OS were significantly decreased in patients with myosteatosis (PFS: median 32.0 months (95% CI 20.5.5-42.2) vs. 66.4 months without myosteatosis (95% CI 42.5-not reached), p < .001); OS: median 58.6 (95% CI 51.3-90.2) vs. not reached, p < .001). Myosteatosis remained an independent predictor of OS in multivariable analyses (HR: 1.98; 95%-CI: 1.20-3.27).
Myosteatosis seems fairly prevalent in patients with newly diagnosed MM and associated with impaired overall survival. Prospective clinical trials are required to better understand the role of myosteatosis in MM patients.
骨骼肌脂肪浸润（肌脂肪变性）与身体虚弱加剧、肌肉及运动功能下降相关，这在多发性骨髓瘤（MM）患者中似乎相当普遍。本研究旨在确定通过CT评估的肌脂肪变性对无进展生存期（PFS）和总生存期（OS）的预后价值。
这项经机构审查委员会批准的队列研究纳入了在一家大学医院接受治疗且在基线时接受CT检查的新诊断MM患者。通过国际骨髓瘤工作组虚弱评分和修订的骨髓瘤合并症指数进行老年评估。通过测量椎旁肌放射密度来确定肌脂肪变性。统计分析包括单变量和多变量Cox比例风险模型以及Kaplan-Meier法。
共分析了226例新诊断的MM患者（中位年龄：65岁[范围：29 - 89岁]，63%为男性，平均BMI：25[14 - 42]）。肌脂肪变性的患病率为51%。国际分期系统III期患者的肌肉放射密度明显低于I期患者（p < 0.001），表明晚期疾病患者的肌肉脂肪浸润更高。肌脂肪变性患者的PFS和OS均显著降低（PFS：中位32.0个月（95%CI 20.5 - 42.2），无肌脂肪变性患者为66.4个月（95%CI 42.5 - 未达到），p < 0.001）；OS：中位58.6（95%CI 51.3 - 90.2），无肌脂肪变性患者未达到，p < 0.001）。在多变量分析中，肌脂肪变性仍然是OS的独立预测因素（HR：1.98；95%CI：1.20 - 3.27）。
肌脂肪变性在新诊断的MM患者中似乎相当普遍，且与总生存期受损相关。需要进行前瞻性临床试验以更好地了解肌脂肪变性在MM患者中的作用。
