고형암 환자에서 골수전이 예측 판정 기준에 관한 연구 = A Study on the Criteria Predictive of Bone Marrow Metastasis고형암 환자에서 골수전이 예측 판정 기준에 관한 연구

다국어 초록 (Multilingual Abstract)

The evaluation of bone marrow metastasis in cancer patients is essential for staging and establishing the treatment streategies. Hower, the bone marrow examination is generally not performed in recently diagnosed cancer patients unless they have obvious hematologic abnormalities, Though a number of parameters have been reported to correlate with bone marrow metastasis, no single clinical parameter has been considered to be highly predictive of it. The present study was designed to evaluate the parameters and to establish the criteria which best met the bone marrow metastasis, retrospectively in 60 cancer patients with bone marrow metastasis(subject group) and 41 without it (control group), underwent bone marrow aspiration and/or biopsy from Jan. 1977 to Dec. 1985. Stepwise logistic regression analysis was employed using a statistical package program, BMDPLR, at the younsei University Computer Center. Univariate anaylsis showed 11 significant parameters as follows; bone pain, nucleated RBC, fragmented RBC, immature WBC, platelet count, alkaline phosphatase (ALP), total bilirubin, SGOT, LDH, and uric acid. Stepwise logistic regression analysis revealed the most significant 4 variables as follows; bone pain, ALP>115 IU/L, platelet<100,000/mm³, and fragmented RBC. Then two sets of decision rule judging a patient to have bone marrow metastasis were introduced. Decision rule I: the calculated predicted probability greater than 0.426, by the equation Pr(M)=1-[1+exp {1.050 (bone pain)+2.594 (fragmented RRC)+1.115 (platelet<100,000/mm³)+1.411 (ALP) 115 IU/L)}], where positive and negative result of the each variable corresponds the value +1 and -1, respectively. Decision rule II for the convenience of clinicians; at least 2 out of 4 major correlates, or 1 major correlates and at least 2 out of 5 minor correlates, where major correlates are the above 5 variables of the most significance and minor correlates are immature WBC, nucleated RBC, LDH > 125IU/L, SGOT>30IU/L and hematocrit<30%. The sensitivity and specificity of the decision rule I and II are 90.0%, 85.7% and 92.5%, 70.6%, respectively. In conclusion, the above rules should aid the physicians in staging and establishing the treatment strategy for cancer patients with high probabilty of bone marrow metastasis.