Which Factors Are Associated with Adverse Prognosis in Multiple Myeloma Patients After Surgery? - Preliminary Establishment and Validation of the Nomogram

Overview

Journal World J Surg Oncol

Publisher Biomed Central

Specialties General Surgery
Oncology

Date 2024 Jun 25

PMID 38918829

Authors

Jun-Peng Liu

Zi-Yu Xu

Yue Wu

Xiang-Jun Shi

Ming Shi

Meng Li

Xin-Ru Du

Xing-Chen Yao

Affiliations

Soon will be listed here.

Abstract

Background: To investigate the prognosis of patients with Multiple Myeloma (MM) after surgery, analyze the risk factors leading to adverse postoperative outcomes, and establish a nomogram.

Methods: Clinical data from 154 patients with MM who underwent surgery at our institution between 2007 and 2019 were retrospectively analyzed. Assessing and comparing patients' pain levels, quality of life, and functional status before and after surgery (P < 0.05) were considered statistically significant. The Kaplan-Meier survival curve was used to estimate the median survival time. Adverse postoperative outcomes were defined as worsened symptoms, lesion recurrence, complication grade ≥ 2, or a postoperative survival period < 1 year. Logistic regression analysis was used to determine the prognostic factors. Based on the logistic regression results, a nomogram predictive model was developed and calibrated.

Results: Postoperative pain was significantly alleviated in patients with MM, and there were significant improvements in the quality of life and functional status (P < 0.05). The median postoperative survival was 41 months. Forty-nine patients (31.8%) experienced adverse postoperative outcomes. Multivariate logistic regression analysis identified patient age, duration of MM, International Staging System, preoperative Karnofsky Performance Status, and Hb < 90 g/L as independent factors influencing patient prognosis. Based on these results, a nomogram was constructed, with a C-index of 0.812. The calibration curve demonstrated similarity between the predicted and actual survival curves. Decision curve analysis favored the predictive value of the model at high-risk thresholds from 10% to-69%.

Conclusion: This study developed a nomogram risk prediction model to assist in providing quantifiable assessment indicators for preoperative evaluation of surgical risk.

References

Aminizadeh S, Heidari A, Dehghan M, Toumaj S, Rezaei M, Jafari Navimipour N . Opportunities and challenges of artificial intelligence and distributed systems to improve the quality of healthcare service. Artif Intell Med. 2024; 149:102779. DOI: 10.1016/j.artmed.2024.102779. View

Hou Z, Kang Y, Yang G, Wang Z, Wang F, Yu Y . Pleural effusion-based nomogram to predict outcomes in unselected patients with multiple myeloma: a large single center experience. Ann Hematol. 2021; 100(7):1789-1801. DOI: 10.1007/s00277-021-04484-1. View

Chen X, Chen J, Zhang W, Sun R, Liu T, Zheng Y . Prognostic value of diametrically polarized tumor-associated macrophages in multiple myeloma. Oncotarget. 2018; 8(68):112685-112696. PMC: 5762541. DOI: 10.18632/oncotarget.22340. View

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

Pulte D, Jansen L, Brenner H . Changes in long term survival after diagnosis with common hematologic malignancies in the early 21st century. Blood Cancer J. 2020; 10(5):56. PMC: 7221083. DOI: 10.1038/s41408-020-0323-4. View

Ozturk R, Amer K, Gencoglu A, Ozturk F, Kasali K, Aytekin M . Is surgical indication in multiple myeloma a poor prognosis sign? SEER database analysis. Clin Transl Oncol. 2023; 26(2):524-531. DOI: 10.1007/s12094-023-03273-8. View

Hillengass J, Usmani S, Rajkumar S, Durie B, Mateos M, Lonial S . International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders. Lancet Oncol. 2019; 20(6):e302-e312. DOI: 10.1016/S1470-2045(19)30309-2. View

Terebelo H, Abonour R, Gasparetto C, Toomey K, Durie B, Hardin J . Development of a prognostic model for overall survival in multiple myeloma using the Connect MM Patient Registry. Br J Haematol. 2019; 187(5):602-614. PMC: 6899784. DOI: 10.1111/bjh.16139. View

Greipp P, San Miguel J, Durie B, Crowley J, Barlogie B, Blade J . International staging system for multiple myeloma. J Clin Oncol. 2005; 23(15):3412-20. DOI: 10.1200/JCO.2005.04.242. View

10.

Lee B, Park Y, Kim J, Kang K, Lee S, Kim S . PD-L1 expression in bone marrow plasma cells as a biomarker to predict multiple myeloma prognosis: developing a nomogram-based prognostic model. Sci Rep. 2020; 10(1):12641. PMC: 7387472. DOI: 10.1038/s41598-020-69616-5. View

11.

Zhang L, Chen S, Wang W, Wang Y, Liang Y . A prognostic model for patients with primary extramedullary multiple myeloma. Front Cell Dev Biol. 2022; 10:1021587. PMC: 9732373. DOI: 10.3389/fcell.2022.1021587. View

12.

Shander A . Preoperative anemia and its management. Transfus Apher Sci. 2014; 50(1):13-5. DOI: 10.1016/j.transci.2013.12.006. View

13.

Moisset X, Attal N, Ciampi de Andrade D . An Emoji-Based Visual Analog Scale Compared With a Numeric Rating Scale for Pain Assessment. JAMA. 2022; 328(19):1980. DOI: 10.1001/jama.2022.16940. View

14.

Zijlstra H, Pierik R, Crawford A, Tobert D, Wolterbeek N, Oosterhoff J . Analysis of complications and revisions after spine surgery in 270 multiple myeloma patients with spinal involvement. Eur Spine J. 2023; 32(12):4335-4354. DOI: 10.1007/s00586-023-07903-1. View

15.

Lu X, Liu W, Zhang L, Chen X, Yang L, Yao Q . Eastern Cooperative Oncology Group, 2-microglobulin, hemoglobin, and lactate dehydrogenase can predict early grade ≥ 3 infection in patients with newly diagnosed multiple myeloma: A real-world multicenter study. Front Microbiol. 2023; 14:1114972. PMC: 9911534. DOI: 10.3389/fmicb.2023.1114972. View

16.

Topkar O, Erol B . Clinical outcomes and complications of surgical interventions for multiple myeloma lesions in the extremities and pelvis: A retrospective clinical study. Acta Orthop Traumatol Turc. 2021; 55(2):159-165. PMC: 11229620. DOI: 10.5152/j.aott.2021.20130. View

17.

Quidet M, Zairi F, Boyle E, Facon T, Vieillard M, Machuron F . Evaluation of the Relevance of Surgery in Patients with Multiple Myeloma Harboring Symptomatic Spinal Involvement: A Retrospective Case Series. World Neurosurg. 2018; 114:e356-e365. DOI: 10.1016/j.wneu.2018.02.184. View

18.

Kashyap R, Singh A, Kumar P . Prevalence of autoimmune hemolytic anemia in multiple myeloma: A prospective study. Asia Pac J Clin Oncol. 2014; 12(2):e319-22. DOI: 10.1111/ajco.12230. View

19.

Terpos E, Zamagni E, Lentzsch S, Drake M, Garcia-Sanz R, Abildgaard N . Treatment of multiple myeloma-related bone disease: recommendations from the Bone Working Group of the International Myeloma Working Group. Lancet Oncol. 2021; 22(3):e119-e130. DOI: 10.1016/S1470-2045(20)30559-3. View

20.

Sun T, Wang S, Sun H, Wen J, An G, Li J . Improved survival in multiple myeloma, with a diminishing racial gap and a widening socioeconomic status gap over three decades. Leuk Lymphoma. 2017; 59(1):49-58. DOI: 10.1080/10428194.2017.1335398. View