Washington Univ School of Medcn, St. Louis, MO
Amber Afzal , Mark A. Fiala , Meagan Jacoby , Matthew Walter
Background: Prognostication of patients with myelodysplastic syndromes (MDS) using IPSS-R is not possible in administrative database analysis. In 2014, a claims-based prognostic scoring system, the SEER-Medicare MDS Risk Score (SMMRS) was developed to risk-stratify MDS patients for overall survival using ICD9 codes {Uno, 2014}. In 2015, ICD9 codes were replaced by ICD10 codes. In this study, we updated SMMRS with inclusion of both ICD-9 and -10 codes, and studied its predictive value for overall survival, leukemia-free survival and initiation of treatment among MDS patients. Methods: Patients with MDS were identified through ICD-O-03 codes in the SEER-Medicare database between 2007 and 2017. SMMRS was calculated using MDS subtype, age, comorbidities, cytopenias, transfusion-dependence, and recent hospital admissions. We analyzed the association of SMMRS with overall survival, leukemia-free survival (time from MDS diagnosis to leukemia), and initiation of treatment (hypomethylating agents /stem cell transplant) in Cox proportional hazards models while adjusting for potential confounders. Results: Patients with MDS (N = 12,710) had a median age of 80 years, half were males, and most were Caucasians. SMMRS stratified patients into low-risk (n = 3155), intermediate-1 risk (n = 3255), intermediate-2 risk (n = 3121), and-high risk (n = 3209) categories at diagnosis. The overall survival, leukemia-free survival and treatment initiation for patients in each SMMRS category is summarized in Table. The 5-year overall survival for the entire cohort was 20%. At 5 years, 10% of the MDS patients had transformed to leukemia, and 1/3rd had started MDS treatment. Conclusions: SMMRS based on ICD-9 and -10 codes predicts overall survival, leukemia-free survival and MDS treatment initiation by stratifying MDS patients into 4 risk-categories. It can be utilized to design/analyze future observational studies.
Overall survival according to SMMRS category (Proportion) | ||||
---|---|---|---|---|
Low-risk | Intermediate-1 risk | Intermediate-2 risk | High-risk | |
3 years | 0.67 | 0.40 | 0.18 | 0.06 |
5 years | 0.50 | 0.23 | 0.09 | 0.02 |
Adjusted Hazards Ratio (of death)# | reference | 1.91 (1.80-2.04) | 3.34 (3.14-3.55) | 5.50 (5.16-5.86) |
Incidence of leukemia according to SMMRS category (Proportion) | ||||
Low-risk | Intermediate-1 risk | Intermediate-2 risk | High-risk | |
3 years | 0.05 | 0.06 | 0.10 | 0.15 |
5 years | 0.07 | 0.08 | 0.13 | * |
Adjusted Hazards Ratio# | reference | 1.25 (0.99-1.56) | 2.00 (1.59-2.51) | 2.93 (2.31-3.72) |
Treatment initiation according to SMMRS category (Proportion) | ||||
Low-risk | Intermediate-1 risk | Intermediate-2 risk | High-risk | |
3 years | 0.25 | 0.30 | 0.33 | 0.40 |
5 years | 0.30 | 0.33 | 0.35 | * |
Adjusted Hazards Ratiõ | reference | 1.28 (1.15-1.41) | 1.59 (1.43-1.76) | 2.34 (2.11-2.59) |
* Unable to estimate as few patients were alive at this time-point # Adjusted for Gender, Race, Ethnicity, MDS treatment ̃ Adjusted for Gender, Race, Ethnicity
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