多发性骨髓瘤67例生存期及影响因素分析

Survival time and correlation factors of multiple myeloma——a report of 67 cases

目的多发性骨髓瘤(MM)是一种异质性的浆细胞肿瘤,预后不良。本研究旨在探讨MM患者的预后因素和临床适用的分期。方法收集1998年12月至2010年5月67例确诊MM患者的临床和实验室指标,并将患者分别按照Bataille分期、Durie-Salmon(DS)分期和国际分期系统(ISS)分期法进行分期,进行Log-rank检验单因素分析和COX回归模型多因素分析,评价MM预后因素,比较三种分期法的生存情况。结果 67例患者男41例,女26例,中位年龄62岁,中位生存期33个月,2年生存率74.1%,5年生存率25.6%。单因素分析结果提示年龄、骨髓浆细胞总数、白蛋白、血清β2微球蛋白(β2-MG)、肌酐、乳酸脱氢酶、血钙、尿酸与预后相关,多因素分析显示β2-MG、白蛋白、肌酐和年龄为独立预后因素。DS分期中三期间生存期存在显著差异,ISS分期和Bataille分期中,Ⅱ期和Ⅲ期的生存期存在统计学差异,而Ⅰ期和Ⅱ期的生存期无统计学差异。结论 MM患者高β2-MG、低白蛋白、高肌酐、高龄者预后较差。DS分期对我国患者比较适合。

Objective Multiple myeloma(MM) is a heterogeneous disease of plasma cell tumor with poor prognosis.This study was to analysis the prognostic factors of MM in China,and find the most suitable clinical staging systems.Methods Univariate and multivariate analyses were carried out on clinical and laboratory indexes from 67 MM patients,which were recruited from December 1998 to May 2010.These MM patients were classified according to Durie Salmon staging system,International staging system and Bataille staging system.The prognosis factors were analyzed by Log-Rank test and COX regression model,and the survival rates of 3 staging systems were compared.Results Among the 67 patients,41 were men and 26 were women,with median age of 62 years and median survival time of 33 months.The 2 and 5 year survival rates were 74.1% and 25.6%.Univariate analysis identified 8 prognostic factors:age,the amount of the bone marrow plasma cells,serum albumin,serum beta2-microglobulin(β2-MG),creatinine,lactate dehydrogenase,serum calcium and serum uric acid.Multivariate analysis showed that β2-MG,albumin,creatinine and age were independent prognostic factors.Significant differences of survival period existed among the 3 groups classified according to Durie Salmon staging system as well as between group Ⅱand group Ⅲ of International staging system and Bataille staging system.However,no significant difference was found between group Ⅰand group Ⅱ of International staging system and Bataille staging system.Conclusions High level of β2-MG,low level of albumin,high level of creatinine and old age are correlated to poor prognosis.Durie Salmon staging system is suitable for Chinese MM patients.