中国全科医学Issue(6)：658-665,8.DOI:10.3969/j.issn.1007-9572.2016.06.008
多发性骨髓瘤预后的影响因素研究
Influencing Factors for the Prognosis of Multiple Myeloma
摘要
Abstract
Objective To investigate the significance of clinical features,laboratory indexes and treatment regimen on the prognosis of multiple myeloma( MM) . Methods Enrolled 202 patients who were newly diagnosed with MM and had complete follow - up data in the Department of Hematology of Beijing Jishuitan Hospital From January 2000 to March 2012. All the patients underwent chemotherapy. Among them,42 patients underwent chemoradiotherapy. The observed indexes included gender, age,typing, having severe anemia or not, blood level of β2 - microglobulin, C - reactive protein level, having hypoalbuminemia or not,blood calcium level,lactic dehydrogenase level,proportion of bone marrow plasma cells,bone disease grading( MBD grading),ECOG score,complex karyotype( G banding karyotype analysis),amyloidosis,renal injury, paraplegia,whether treatment achieved complete remission(CR)and whether thalidomide maintenance therapy was conducted or not(treatment duration≥6 months). Follow - up ended in March 2015,lasting for 1. 0 - 180. 0 months. Multivariate Cox proportionnal hazards regression analysis and survival curves analysis were conducted on the correlation of DS staging,ISS staging and other factors with the overall survival(OS)and progression free survival(PFS)of MM patients. A total of 19 patients died 6 months after diagnosis,and multivariate Logistic regression analysis was employed to investigate influencing factors for early death. According to common influencing factors for OS and PFS and ISS staging,the patients were divided into three groups:high risk group,average risk group and low risk group. The prognosis of the three groups was analyzed. Results Among 202 MM patients,53(26. 2% )patients had CR;96(47. 5% )had very good partial response(VGPR);29(14. 4% )patients had partial remission(PR);the overall effective rate was 88. 1%. By the end of follow - up,120 patients died. One - year,three -year,five - year and ten - year survival rates were 80. 7% ,70. 6% ,36. 1% and 7. 6% respectively. OS was 1. 0 - 180. 0 months,and median OS was 51. 0 months;PFS was 1. 0 - 91. 0 months,and median PFS was 38. 0 months. Multivariate Cox proportional hazards regression analysis showed that age,severe anemia,hypoalbuminemia,complex karyotype,amyloidosis, paraplegia and thalidomide maintenance treatment had regression relation with OS(P < 0. 05);age,severe anemia,complex karyotype,paraplegia and thalidomide maintenance treatment had regression relation with PFS( P < 0. 05 ) . Patients with different DS stages were not significantly different in OS( χ2 = 1. 710,P > 0. 05). Patients with different DS stages were significantly different in PFS(χ2 = 12. 222,P < 0. 05). Patients with different ISS stages were significantly different in OS and PFS(χ2 values were 15. 037 and 32. 222,P < 0. 05). Univariate analysis showed that patients with severe anemia〔32% (8/ 25)vs. 6. 2% (11 / 177),χ2 = 0. 512,P = 0. 039〕and amyloidosis〔66. 7% (4 / 6)vs. 7. 7% (15 / 196),χ2 = 11. 460,P= 0. 007〕were significantly different from patients without them. Multivariate Logistic regression analysis showed that amyloidosis was an independent influencing factor for early death〔β = 2. 178,SE = 0. 915,Wald χ2 = 5. 669,P = 0. 017,OR = 8. 826, 95% CI(1. 470,53. 002)〕. Patients with different risk gradings were significantly different in OS and PFS( P < 0. 001). Conclusion Influencing factors for the prognosis of MM patients are complex and diverse,including advanced age,combined severe anemia,hypoproteinemia,complex karyotype,amyloidosis and paraplegia. Patients receiving thalidomide maintenance treatment have longer survival time. ISS staging has greater significance than DS staging in the prognosis. Patients combined with amyloidosis have higher risk for early death. Risk grading by common influencing factors for OS and PFS and ISS staging are of significance in the prognosis of patients.关键词
多发性骨髓瘤/预后/影响因素分析Key words
Multiple myeloma/Prognosis/Influence factor analysis分类
医药卫生引用本文复制引用
陆敏秋,项秋晴,褚彬,白砚霞,左杏果,吴梦青,石磊,付丽娜,高珊,房立娟..多发性骨髓瘤预后的影响因素研究[J].中国全科医学,2016,(6):658-665,8.基金项目
北京市医院管理局临床医学发展专项经费资助 （）
