Application of morphometrics as a predictor for survival in female patients with breast cancer spinal metastasis, a retrospective cohort study

Publication date: Available online 14 March 2018
Source:The Spine Journal
Author(s): Hesham Mostafa Zakaria, Lara Massie, Azam Basheer, David Boyce-Fappiano, Erinma Elibe, Lonni Schultz, Ian Lee, Brent Griffith, Farzan Siddiqui, Victor Chang
BACKGROUND CONTEXTThe 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. Analytic 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.PURPOSEOur study evaluates whether morphometrics is predictive of survival in patients with breast cancer spinal metastasis.DESIGNObservational retrospective cohort studyPATIENT SAMPLEFemale patients with breast cancer spinal metastases patients who have undergone stereotactic body radiation therapy (SBRT).OUTCOME MEASURESOverall survival was the primary outcome measure.METHODSMorphometric measurements were taken of the psoas muscle using computed tomography scans of the lumbar spine. We then stratified patients into tertiles based on psoas muscle area. There are no sources of funding for this project, and no conflicts of interest.RESULTSWe identified 118 patients, with a median survival of 104 days (95% CI=73 to 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 as compared to the highest tertile, 68 days vs 148, hazard ratio 1.76 (95% CI=1.08-2.89), p = 0.024. The shorter survival was also true for the lowest tertile vs the middle tertile, 68 days vs 167, hazard ratio 1.95 (95%CI=1.19-3.19), p = 0.007. Kaplan-Meier survival curves are used to visually illustrate the differences in survival between different tertiles.CONCLUSIONSMorphometric analysis of psoas muscle size in patients with breast cancer metastases to the spine was effective in identifying patients at risk for 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.



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