Prognostic Effect of Sarcopenia and Nutritional Factors on Survival in Patients With Newly Diagnosed Multiple...

Multiple myeloma (MM) is a hematological malignancy associated with poor prognosis. Prognostic prediction based on patient fitness may facilitate the optimization of therapeutic strategies. This study aimed to explore the prognostic significance of sarcopenia, the prognostic nutritional index (PNI) and the controlling nutritional status (CONUT) on the survival of patients with MM.

A retrospective analysis was conducted on patients with newly diagnosed MM (NDMM) at Jiangsu Province Hospital between January 2016 and December 2022. Skeletal muscle mass was measured using CT images at diagnosis and normalized for stature to calculate the skeletal muscle index (SMI). Patients with low SMI were defined as sarcopenic. Thresholds for sarcopenia, PNI and CONUT score were determined using X-tile plot, and participants were categorized accordingly. The Kaplan-Meier survival analysis was used to evaluate the relationship between these indicators and prognosis. Independent prognostic predictors of overall survival (OS) were identified using the multivariate Cox regression model.

This study included 214 patients diagnosed with NDMM with a median age of 61.7 ± 9.3 years, of whom 87 (40.7%) were female. Sarcopenia was identified in 80 patients (37.4%), with a higher prevalence in women (p = 0.015), those aged over 65 years (p = 0.013) and patients with a BMI ≤ 24 kg/m² (p < 0.001). Patients with sarcopenia exhibited shorter progression-free survival (PFS, p = 0.0497) and OS (p < 0.0001). Survival curves revealed that low PNI and high CONUT score were significantly correlated with adverse PFS and OS (all p < 0.05). A combined model incorporating sarcopenia, PNI and CONUT score demonstrated a strong association with PFS (p = 0.0007) and OS (p < 0.0001), and patients with concurrent sarcopenia, low PNI and high CONUT score exhibited the poorest survival rates. Multivariate Cox analysis indicated that sarcopenia was a significant and independent predictor of shorter OS (hazard ratio [HR] = 2.748, 95% confidence interval [CI]: 1.495-5.052, p = 0.001) in patients with NDMM.

Sarcopenia is an independent prognostic indicator of OS in patients with NDMM. The integration of PNI and CONUT scores provides a comprehensive prognostic model for prognosis in patients with MM, highlighting the importance of functional status and nutritional assessments in clinical management.