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

doi:10.11958/20230241

Abstract

Abstract:

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 Ca²⁺ 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-rank χ²=82.329, P<0.001). The multivariate Cox regression analysis showed that after adjusting pathological classification, site of bone metastasis, brain metastasis and Ca²⁺, 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.

Key words: breast neoplasms, prognosis, bone metastasis, pectoralis muscle index

CLC Number:

R737.9

Figures/Tables 5

References 18

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组别	n		年龄/岁	病理分型										Ki-67≥14%		骨转移部位
组别	n		年龄/岁	luminal A		luminal B（HER2-）		HER2+（HR+）		HER2+（HR-）		三阴性		Ki-67≥14%		四肢骨	中轴骨		两者均有
高PMI组	93		55（49，62）	26（28.0）		44（47.3）		12（12.9）		0（0.0）		11（11.8）		54（58.1）		38（40.9）	23（24.7）		32（34.4）
低PMI组	104		52（46，63）	29（27.9）		37（35.6）		6（5.8）		21（20.2）		11（10.6）		79（76.0）		16（15.4）	20（19.2）		68（65.4）
χ²或Z			1.569	23.227^＊＊										7.170^＊＊		21.585^＊＊
组别		骨转移数目≥5个			放疗		应用骨保护剂		肺转移		肝转移		脑转移		Ca²⁺/（mmol/L）			死亡
高PMI组		39（41.9）			19（20.4）		77（82.8）		39（41.9）		31（33.3）		9（9.7）		2.33（2.23，2.40）			59（63.4）
低PMI组		52（50.0）			14（13.5）		87（83.7）		48（46.2）		43（41.3）		28（26.9）		2.40（2.30，2.48）			98（94.2）
χ²或Z		1.285			1.710		0.026		0.354		1.344		9.572^＊＊		2.268^＊			28.763^＊＊

组别	n		年龄/岁	病理分型										Ki-67≥14%		骨转移部位
组别	n		年龄/岁	luminal A		luminal B（HER2-）		HER2+（HR+）		HER2+（HR-）		三阴性		Ki-67≥14%		四肢骨	中轴骨		两者均有
高PMI组	93		55（49，62）	26（28.0）		44（47.3）		12（12.9）		0（0.0）		11（11.8）		54（58.1）		38（40.9）	23（24.7）		32（34.4）
低PMI组	104		52（46，63）	29（27.9）		37（35.6）		6（5.8）		21（20.2）		11（10.6）		79（76.0）		16（15.4）	20（19.2）		68（65.4）
χ²或Z			1.569	23.227^＊＊										7.170^＊＊		21.585^＊＊
组别		骨转移数目≥5个			放疗		应用骨保护剂		肺转移		肝转移		脑转移		Ca²⁺/（mmol/L）			死亡
高PMI组		39（41.9）			19（20.4）		77（82.8）		39（41.9）		31（33.3）		9（9.7）		2.33（2.23，2.40）			59（63.4）
低PMI组		52（50.0）			14（13.5）		87（83.7）		48（46.2）		43（41.3）		28（26.9）		2.40（2.30，2.48）			98（94.2）
χ²或Z		1.285			1.710		0.026		0.354		1.344		9.572^＊＊		2.268^＊			28.763^＊＊

因素	β	SE	Wald χ²	P	HR	HR95%CI
未调整混杂因素
低PMI vs. 高PMI	1.463	0.172	72.097	<0.001	4.318	3.081~6.053
调整混杂因素
低PMI vs. 高PMI	1.375	0.190	52.558	<0.001	3.954	2.727~5.734
病理分型			17.724	0.001
luminal B（HER2-） vs. luminal A	-0.260	0.201	1.667	0.197	0.771	0.520~1.144
HER2+（HR+） vs. luminal A	0.623	0.301	4.279	0.039	1.864	1.033~3.363
HER2+（HR-） vs. luminal A	0.682	0.284	5.775	0.016	1.977	1.134~3.447
三阴性 vs. luminal A	0.223	0.292	0.584	0.445	1.250	0.705~2.218
骨转移部位			14.133	<0.001
中轴骨 vs. 四肢骨	0.496	0.251	3.913	0.048	1.642	1.005~2.683
两者均有 vs. 四肢骨	0.788	0.211	14.001	<0.001	2.200	1.456~3.325
脑转移	0.784	0.202	15.105	<0.001	2.189	1.475~3.251
Ca²⁺	0.348	0.309	1.263	0.261	1.416	0.772~2.596

因素	β	SE	Wald χ²	P	HR	HR95%CI
未调整混杂因素
低PMI vs. 高PMI	1.463	0.172	72.097	<0.001	4.318	3.081~6.053
调整混杂因素
低PMI vs. 高PMI	1.375	0.190	52.558	<0.001	3.954	2.727~5.734
病理分型			17.724	0.001
luminal B（HER2-） vs. luminal A	-0.260	0.201	1.667	0.197	0.771	0.520~1.144
HER2+（HR+） vs. luminal A	0.623	0.301	4.279	0.039	1.864	1.033~3.363
HER2+（HR-） vs. luminal A	0.682	0.284	5.775	0.016	1.977	1.134~3.447
三阴性 vs. luminal A	0.223	0.292	0.584	0.445	1.250	0.705~2.218
骨转移部位			14.133	<0.001
中轴骨 vs. 四肢骨	0.496	0.251	3.913	0.048	1.642	1.005~2.683
两者均有 vs. 四肢骨	0.788	0.211	14.001	<0.001	2.200	1.456~3.325
脑转移	0.784	0.202	15.105	<0.001	2.189	1.475~3.251
Ca²⁺	0.348	0.309	1.263	0.261	1.416	0.772~2.596