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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Interaction between age and gender on survival outcomes in extramedullary multiple myeloma over the past two decades
Ayrton I Bangolo, Pierre Fwelo, Chinmay Trivedi, Sowmya Sagireddy, Hamed Aljanaahi, Auda Auda, Maryama Mohamed, Sonia Onyeka, Miriam Fisher, Jyoti Thapa, Erwin J Tabucanon, Lyuben Georgiev, Annetta Wishart, Shilpee Kumari, Conrad Erikson, Mary Bangura, Orent Paddy, Rashmi Madhukar, Eugenio L Gomez, Joshua Rathod, Mansi Naria, Basel Hajal, Mohammad Awadhalla, David Siegel, Harsh Parmar, Noa Biran, David H Vesole, Pooja Phull, Simcha Weissman
Ayrton I Bangolo, Chinmay Trivedi, Sowmya Sagireddy, Hamed Aljanaahi, Auda Auda, Maryama Mohamed, Sonia Onyeka, Miriam Fisher, Jyoti Thapa, Erwin J Tabucanon, Lyuben Georgiev, Annetta Wishart, Shilpee Kumari, Conrad Erikson, Mary Bangura, Orent Paddy, Rashmi Madhukar, Eugenio L Gomez, Joshua Rathod, Mansi Naria, Basel Hajal, Mohammad Awadhalla, Simcha Weissman, Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
Pierre Fwelo, Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX 77204, United States
David Siegel, Harsh Parmar, Noa Biran, David H Vesole, Pooja Phull, Division of Myeloma, John Theurer Cancer Center, Hackensack, NJ 07601, United States
Author contributions: Bangolo AI searched the literature, wrote, and revised the manuscript; Fwelo P extracted and analysed the data, revised, and edited the manuscript; Trivedi C, Sagireddy S, Aljanaahi H, Auda A, Mohamed M, Onyeka S, Fisher M, Thapa J, Tabucanon EJ, Georgiev L, Wishart A, Kumari S, Erikson C, Bangura M, Paddy O, Madhukar R, Gomez EL, Rathod J, Naria M, Hajal B, Awadhalla M, Siegel D, Parmar H, Biran N, and Vesole DH revised and edited the manuscript; Phull P and Weissman S revised and approved the final version and are the article’s guarantors; All authors certify that they contributed sufficiently to the intellectual content and data analysis; Each author has reviewed the final version of the manuscript and approved it for publication.
Institutional review board statement: The study protocol was reviewed by the Ethics Committee at Palisades Medical Center and the need for IRB approval was waived as the SEER database is a public-use dataset.
Informed consent statement: The Surveillance, Epidemiology, and End Results (SEER) database was a public-use dataset, of which the informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data used and/or analyzed in this study are available in the Surveillance, Epidemiology, and End Results (SEER) Database of the National Cancer Institute (
http://seer.cancer.gov).
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ayrton I Bangolo, MBBS, MD, Doctor, Department of Medicine, Palisades Medical Center, 7600 River Road, North Bergen, NJ 07047, United States. ayrtonbangolo@yahoo.com
Received: December 17, 2022
Peer-review started: December 17, 2022
First decision: February 20, 2023
Revised: February 20, 2023
Accepted: March 17, 2023
Article in press: March 17, 2023
Published online: April 24, 2023
Processing time: 124 Days and 18.5 Hours
BACKGROUND
Extramedullary multiple myeloma (MM) (EMM) is a rare and aggressive subentity of MM that can be present at diagnosis or develop anytime during the disease course. There is a paucity of data on the clinical characteristics and overall epidemiology of EMM. Furthermore, there is a scarcity of data on how the interaction of age and gender influences the survival of EMM.
AIM
To evaluate the clinical characteristics of patients with EMM over the past 2 decades and to identify epidemiologic characteristics that may impact overall prognosis.
METHODS
A total of 858 patients diagnosed with EMM, between 2000 and 2017, were ultimately enrolled in our study by retrieving the Surveillance, Epidemiology, and End Results database. We analyzed demographics, clinical characteristics, and overall mortality (OM) as well as cancer-specific mortality (CSM) of EMM. Variables with a P value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox model to determine the independent prognostic factors, with a hazard ratio (HR) of greater than 1 representing adverse prognostic factors.
RESULTS
From a sample of 858 EMM, the male gender (63.25%), age range 60-79 years (51.05%), and non-Hispanic whites (66.78%) were the most represented. Central Nervous System and the vertebral column was the most affected site (33.10%). Crude analysis revealed higher OM in the age group 80+ [HR = 6.951, 95% confidence interval (95%CI): 3.299-14.647, P = 0], Non-Hispanic Black population (HR = 1.339, 95%CI: 1.02-1.759, P = 0.036), Bones not otherwise specified (NOS) (HR = 1.74, 95%CI: 1.043-2.902, P = 0.034), and widowed individuals (HR = 2.107, 95%CI: 1.511-2.938, P = 0). Skin involvement (HR = 0.241, 95%CI: 0.06-0.974, P = 0.046) and a yearly income of $75000+ (HR = 0.259, 95%CI: 0.125-0.538, P = 0) had the lowest OM in the crude analysis. Crude analysis revealed higher CSM in the age group 80+, Non-Hispanic Black, Bones NOS, and widowed. Multivariate cox proportional hazard regression analyses only revealed higher OM in the age group 80+ (HR = 9.792, 95%CI: 4.403-21.774, P = 0) and widowed individuals (HR = 1.609, 95%CI: 1.101-2.35, P = 0.014). Multivariate cox proportional hazard regression analyses of CSM also revealed higher mortality of the same groups. Eyes, mouth, and ENT involvement had the lowest CSM in the multivariate analysis. There was no interaction between age and gender in the adjusted analysis for OM and CSM.
CONCLUSION
EMM is a rare entity. To our knowledge, there is a scarcity of data on the clinical characteristics and prognosis factors of patients with extramedullary multiple myeloma. In this retrospective cohort, using a United States-based population, we found that age, marital status, and tumor site were independent prognostic factors. Furthermore, we found that age and gender did not interact to influence the mortality of patients with EMM.
Core Tip: Very little is known about extramedullary multiple myeloma (EMM), owing to its rarity and scarcity of data on the subject. So far it was found that advanced age was the single most important prognostic value for poor outcome in EMM. However, how age interacts with gender to affect mortality in EMM remains unknown. We found that age did not interact with gender to affect mortality in EMM.
