TY - JOUR
T1 - Application of morphometrics as a predictor for survival in female patients with breast cancer spinal metastasis
T2 - a retrospective cohort study
AU - Zakaria, Hesham Mostafa
AU - Massie, Lara
AU - Basheer, Azam
AU - Boyce-Fappiano, David
AU - Elibe, Erinma
AU - Schultz, Lonni
AU - Lee, Ian
AU - Griffith, Brent
AU - Siddiqui, Farzan
AU - Chang, Victor
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/10
Y1 - 2018/10
N2 - Background Context: The current standard of care for prediction of survival of cancer staging is based on TNM staging. However, for patients with spinal metastasis, who all have identical stage IV disease, identifying accurate prognostic markers of survival would allow better treatment stratification between more aggressive treatment strategies or palliation. Analytical morphometrics enables physicians to quantify patient frailty by measuring lean muscle mass. Morphometrics also predicts survival in patients with lung cancer metastases to the spine. Purpose: Our study evaluates whether morphometrics is predictive of survival in patients with breast cancer spinal metastasis. Design: This is an observational retrospective cohort study. Patient Sample: This study includes female patients with breast cancer spinal metastases and patients who have undergone stereotactic body radiation therapy. Outcome Measures: Overall survival was the primary outcome measure. Methods: Morphometric measurements of the psoas muscle were taken using computed tomography scans of the lumbar spine. We then stratified patients into tertiles based on the psoas muscle area. Results: We identified 118 patients, with a median survival of 104 days (95% confidence interval [CI]=73–157 days). Overall survival was not associated with age, chemotherapy, or number of levels radiated. Patients in the lowest tertile of psoas size had significantly shorter survival compared with the highest tertile (68 days versus 148 days, hazard ratio 1.76 [95% CI=1.08–2.89], p=.024). The shorter survival was also true for the lowest tertile versus the middle tertile (68 days versus 167 days, hazard ratio 1.95 [95% CI=1.19–3.19], p=.007). Kaplan-Meier survival curves were used to visually illustrate the differences in survival between different tertiles. Conclusions: Morphometric analysis of the psoas muscle size in patients with breast cancer metastases to the spine was effective in identifying patients at risk of shorter survival. Further research is needed to validate these results, as well as to see if these methodologies can be applied to other cancer histologies.
AB - Background Context: The current standard of care for prediction of survival of cancer staging is based on TNM staging. However, for patients with spinal metastasis, who all have identical stage IV disease, identifying accurate prognostic markers of survival would allow better treatment stratification between more aggressive treatment strategies or palliation. Analytical morphometrics enables physicians to quantify patient frailty by measuring lean muscle mass. Morphometrics also predicts survival in patients with lung cancer metastases to the spine. Purpose: Our study evaluates whether morphometrics is predictive of survival in patients with breast cancer spinal metastasis. Design: This is an observational retrospective cohort study. Patient Sample: This study includes female patients with breast cancer spinal metastases and patients who have undergone stereotactic body radiation therapy. Outcome Measures: Overall survival was the primary outcome measure. Methods: Morphometric measurements of the psoas muscle were taken using computed tomography scans of the lumbar spine. We then stratified patients into tertiles based on the psoas muscle area. Results: We identified 118 patients, with a median survival of 104 days (95% confidence interval [CI]=73–157 days). Overall survival was not associated with age, chemotherapy, or number of levels radiated. Patients in the lowest tertile of psoas size had significantly shorter survival compared with the highest tertile (68 days versus 148 days, hazard ratio 1.76 [95% CI=1.08–2.89], p=.024). The shorter survival was also true for the lowest tertile versus the middle tertile (68 days versus 167 days, hazard ratio 1.95 [95% CI=1.19–3.19], p=.007). Kaplan-Meier survival curves were used to visually illustrate the differences in survival between different tertiles. Conclusions: Morphometric analysis of the psoas muscle size in patients with breast cancer metastases to the spine was effective in identifying patients at risk of shorter survival. Further research is needed to validate these results, as well as to see if these methodologies can be applied to other cancer histologies.
KW - Breast cancer mortality
KW - Frailty index
KW - Morphometric analysis
KW - Morphometrics
KW - Oncological outcomes
KW - Spinal metastases
KW - Spine complications
KW - Spine surgery
KW - Stage IV breast cancer
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UR - http://www.scopus.com/inward/citedby.url?scp=85044734379&partnerID=8YFLogxK
U2 - 10.1016/j.spinee.2018.03.007
DO - 10.1016/j.spinee.2018.03.007
M3 - Article
C2 - 29550605
AN - SCOPUS:85044734379
SN - 1529-9430
VL - 18
SP - 1798
EP - 1803
JO - Spine Journal
JF - Spine Journal
IS - 10
ER -