Kylies Julian, Brauneck Elias, Priemel Matthias, Kylies Dominik, Weisel Katja, Leonhardt Leon-Gordian, Viezens Lennart
Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany.
III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
World J Surg Oncol. 2025 Sep 17;23(1):336. doi: 10.1186/s12957-025-04007-6.
Frailty and sarcopenia are associated with adverse outcomes in multiple myeloma (MM), but their longitudinal changes and clinical relevance remain unclear. This study evaluated the longitudinal changes in body composition parameters derived from computed tomography (CT) scans and their association with survival and functional decline in MM patients undergoing autologous stem cell transplantation (ASCT).
We analyzed 49 MM patients who underwent three sequential CT scans between 2009 and 2024. CT-based body composition parameters-skeletal muscle index (SMI), paraspinal muscle index (PSMI), psoas muscle index (PMI), skeletal muscle density (SMD), and visceral adipose tissue (VAT)-were measured at the L3 level. Changes in these parameters were assessed over the disease course, and their impact on survival and functional outcome was evaluated using Cox proportional hazards regression models and Kaplan-Meier survival analyses.
CT morphometric body composition parameters declined significantly over time in both sexes. In males, SMI decreased from 48.6 ± 7.1 to 38.4 ± 8.1 cm/m (-21%, p < 0.0001); in females, from 36.6 ± 7.8 to 26.9 ± 4.7 cm/m (-26%, p < 0.0001). VAT declined from 115.9 ± 9.1 to 84.9 ± 9.7 cm in males (-27%, p < 0.0001) and from 63.5 ± 7.1 to 42.1 ± 7.7 cm in females (-34%, p < 0.0001). Patients < 55 years showed comparable declines (e.g., male SMI -21%, VAT -57%). High disease activity was associated with greater SMI (-31.1% vs. -15.5%, p < 0.001) and VAT (-33.5% vs. -26.5%, p < 0.01) losses versus low activity. ASCT patients had larger declines (SMI -31.1% vs. -15.4%, p < 0.001; VAT -33.4% vs. -27.5%, p < 0.01). Cox regression identified reductions in SMI (HR 1.40, 95% CI 1.10-2.20, p = 0.012) and VAT (HR 1.90, 95% CI 1.40-2.90, p = 0.002) as independent predictors of reduced survival. Patients with SMI loss ≥ 10% or VAT loss ≥ 12% had significantly shorter survival (SMI: 80.2 vs. 110.2 months, p = 0.01; VAT: 84.3 vs. 109.4 months, p < 0.01) and greater functional decline, with ECOG worsening from 1 to 3 (p < 0.0001).
Longitudinal changes in SMI and VAT were significant predictors of survival and functional decline in MM patients undergoing ASCT. Routine CT-based body composition assessments might serve as valuable tools for additional risk stratification and potential targeted interventions. These findings underscore the importance of integrating body composition analysis into clinical practice for improved risk stratification and potential implementation of early intervention strategies.
衰弱和肌肉减少症与多发性骨髓瘤（MM）的不良预后相关，但其纵向变化及临床相关性仍不明确。本研究评估了接受自体干细胞移植（ASCT）的MM患者，通过计算机断层扫描（CT）扫描得出的身体成分参数的纵向变化及其与生存和功能衰退的关联。
我们分析了49例在2009年至2024年间接受三次连续CT扫描的MM患者。在L3水平测量基于CT的身体成分参数——骨骼肌指数（SMI）、椎旁肌指数（PSMI）、腰大肌指数（PMI）、骨骼肌密度（SMD）和内脏脂肪组织（VAT）。评估这些参数在疾病过程中的变化，并使用Cox比例风险回归模型和Kaplan-Meier生存分析评估它们对生存和功能结局的影响。
男女两性的CT形态测量身体成分参数均随时间显著下降。男性中，SMI从48.6±7.1降至38.4±8.1cm/m（-21%，p<0.0001）；女性中，从36.6±7.8降至26.9±4.7cm/m（-26%，p<0.0001）。男性的VAT从115.9±9.1降至84.9±9.7cm（-27%，p<0.0001），女性从63.5±7.1降至42.1±7.7cm（-34%，p<0.0001）。年龄<55岁的患者有类似程度的下降（例如，男性SMI下降21%，VAT下降57%）。疾病活动度高的患者与疾病活动度低的患者相比，SMI（-31.1%对-15.5%，p<0.001）和VAT（-33.5%对-26.5%，p<0.01）损失更大。接受ASCT的患者下降幅度更大（SMI：-31.1%对-15.4%，p<0.001；VAT：-33.4%对-27.5%，p<0.01）。Cox回归确定SMI降低（HR 1.40，95%CI 1.10 - 2.20，p = 0.012）和VAT降低（HR 1.90，95%CI 1.40 - 2.90，p = 0.002）是生存降低的独立预测因素。SMI损失≥10%或VAT损失≥12%的患者生存时间显著缩短（SMI：80.2对110.2个月，p = 0.01；VAT：84.3对109.4个月，p<0.01），且功能衰退更严重，东部肿瘤协作组（ECOG）评分从1恶化至3（p<0.0001）。
SMI和VAT的纵向变化是接受ASCT的MM患者生存和功能衰退的重要预测因素。基于CT的常规身体成分评估可能是进行额外风险分层和潜在靶向干预的有价值工具。这些发现强调了将身体成分分析纳入临床实践以改善风险分层和可能实施早期干预策略的重要性。
