基于放射组学评估胸肌指数与乳腺癌骨转移患者预后关系的研究

Relationship between pectoralis muscle index and prognosis of breast cancer patients with bone metastases based on radiomics

目的利用放射组学精准测量胸肌肌肉含量,分析胸肌指数(PMI)与乳腺癌骨转移(BCBM)患者预后的相关性。方法收集197例BCBM患者年龄、病理分型、远处转移、放疗和随访等数据。基于胸部CT结果计算PMI,利用受试者工作特征(ROC)曲线确定PMI的最佳临界值,并分析不同PMI水平患者的临床病理特征和预后差异。结果197例BCBM患者根据PMI最佳临界值分为低PMI组(≤6.295,104例)和高PMI组(>6.295,93例)。与高PMI组相比,低PMI组患者的Ki-67≥14%比例、脑转移率、血清Ca^(2+)浓度和死亡比例增加,病理分型和骨转移部位分布差异有统计学意义(P<0.05)。低PMI组和高PMI组患者的1、3、5年总生存率分别为67.3%、17.3%、5.8%和96.8%、84.9%、36.6%,累积总生存率差异有统计学意义(Log-rankχ^(2)=82.329,P<0.01)。多因素Cox回归分析显示,在校正了病理分型、骨转移部位、脑转移和Ca^(2+)等因素后,低PMI组患者的死亡风险是高PMI组患者的3.954倍。结论PMI下降可增加BCBM患者的死亡风险,BCBM治疗过程中应鼓励对患者进行个性化康复训练和营养支持干预。

Objective To accurately calculate the pectoralis muscle mass and clarify the influence of pectoralis muscle index(PMI)on the survival and prognosis of breast cancer patients with bone metastasis(BCBM)using radiomics.Methods Clinical data of 197 BCBM patients were collected,including age,pathological classification,distant metastasis,radiotherapy and 5-year follow-up data.The PMI was calculated based on chest CT results.The optimal cutoff value for PMI was determined by receiver operating characteristic(ROC)curve,and patients were divided into the low-PMI and the high-PMI groups.Then the clinical and pathological characteristics and prognostic differences of patients with different levels of PMI were analyzed.Results According to the optimal cutoff value for PMI,197 BCBM patients were divided into the low PMI group(≤6.295,104 cases)and the high PMI group(>6.295,93 cases).Compared with the high PMI group,there were significant differences in the proportion of Ki-67≥14%,distribution of bone metastasis sites,and serum Ca^(2+)concentration in the low PMI group(P<0.05).The 1-,3-and 5-year overall survival rates of patients were 67.3%,17.3%,5.8%and 96.8%,84.9%and 36.6%in the low PMI group and the high PMI group,respectively,and the cumulative overall survival rate difference was statistically significant(Log-rankχ^(2)=82.329,P<0.001).The multivariate Cox regression analysis showed that after adjusting pathological classification,site of bone metastasis,brain metastasis and Ca^(2+),the risk of death in the low PMI group was 3.954 times higher than that in the high PMI group.Conclusion The decrease in PMI can increase the risk of death in BCBM patients.Personalized rehabilitation training and nutritional support intervention should be encouraged for patients during the BCBM treatment process.