R-ISS分期系统在初发412例多发性骨髓瘤中的临床应用

Clinical Application of R-ISS Staging System in 412 Newly Diagnosed Patients with Multiple Myeloma

目的:探索R-ISS分期系统对初发多发性骨髓瘤患者的预后评估价值。方法:回顾性分析本院2010年5月到2016年5月收治的412例新诊断的多发性骨髓瘤患者的临床资料。所有患者采用传统化疗和反应停或硼替佐米为基础的诱导化疗方案。根据ISS分期、细胞遗传学、LDH水平将所有患者分为R-ISS-Ⅰ期、R-ISS-Ⅱ期和R-ISS-Ⅲ期,比较3期患者的预后差异。结果:412例患者中,R-ISS-Ⅰ期76例,R-ISS-Ⅱ期259例,R-ISS-Ⅲ期77例,3期患者的中位PFS时间分别是44、25和14个月(P=0.000),中位OS时间分别是未达到、54和25个月(P <0.01)。进一步分析发现,在传统化疗组(P=0.042)、硼替佐米为基础化疗组(P=0.000)、以反应停为基础的化疗组(P=0.000)、移植组(P=0.034)、不同年龄分层组(≤65岁组P=0.000,66-75岁组P=0.001,≥76岁组P=0.000)、肾功能损害组(P=0.003)、髓外浸润组(P=0.000)中,不同R-ISS分期患者的OS时间均有统计学差异。结论:不同R-ISS分期的多发性骨髓瘤患者的PFS和OS时间不同,R-ISS分期系统对初发多发性骨髓瘤的预后评估具有重要临床意义。

Objective: To evaluate the prognostic value of R-ISS staging system in patients with newly diagnosed multiple myeloma(NDMM). Methods: The Chinical data of 412 patients with NDMM in our hospital from May 2010 to May 2016 were retrospectively analyzed. All the patients received conventional chemotherapy or thalidomide or bortezomib-based chemotherapy. All the patients with NDMM were divided into R-ISS-Ⅰ, R-ISS-Ⅱ and R-ISS-Ⅲ groups according to R-ISS staging system on the basis of ISS staging system, cytogenetics and LDH level. The progressionfree survival(PFS) time and overall survival(OS) of different groups were compared. Results: Among all 412 patients, 76 were rated as R-ISS-Ⅰ, 259 as R-ISS-Ⅱ and 77 as R-ISS-Ⅲ. The median PFS time in 3 groups were 44, 25 and 14 months respectively(P<0.01). The median OS time of the 3 groups were not reached 54 and 25 months respectively(P<0.01). Further analysis also found that statistically different survival associated with different R-ISS groups in the conventional chemotherapy group(P<0.05), bortezomib-based chemotherapy group(P<0.01), thalidomide-based chemotherapy group(P<0.01), transplantation group(P<0.05), different-age stratified group( ≤65y P<0.01, 66-75 y P<0.01,≥76y P<0.01), damaged renal function group(P<0.01) and extramedullary infiltration group(P<0.01). Conclusion: PFS and OS in the patients with multiple myeloma were different among three distrinct R-ISS stages. The R-ISS staging system has important clinical significance for the prognosis evaluation of multiple myeloma.