多发性骨髓瘤预后影响因素分析

Influencing factors of prognosis in patients with multiple myeloma

目的探讨影响多发性骨髓瘤(MM)患者总体生存时间(OS)和疾病无进展时间(PFS)的因素,并比较D-S及ISS分期的一致性。方法收集我院初治的176例MM患者临床及实验室资料,并对其进行D-S及ISS分期,应用Kaplan-Meier法计算OS及PFS,Log-Rank检验分析相关因素对OS、PFS的影响,采用Cox回归分析进行多变量分析;采用Kappa分析对D-S分期及ISS分期进行一致性分析。结果不同年龄的MM患者PFS比较,差异有统计学意义(P<0.05)。不同性别、年龄、乳酸脱氢酶、血肌酐、ISS分期及疗效MM患者的OS比较,差异有统计学意义(P<0.05),Cox回归分析结果显示年龄及疗效对OS有独立的预测价值(P<0.05)。ISS分期与D-S分期一致性较好(Kappa=0.358,P<0.001)。结论疗效及年龄可作为MM患者的OS的独立预后因素,年龄与PFS有关,ISS分期与D-S分期有较好的一致性,但ISS分期可更好地评估MM患者的预后。

Objective To explore the factors which influence overall survival（ OS） and progression-free survival（ PFS） in patients with multiple myeloma （ MM ） , and to compare the consistency between Durie-Salmon staging system （ D-S ） staging and International Staging System（ ISS） staging.Methods The clinical features and laboratory data of 176 patients with MM were collected,and the staging was performed using D-S and ISS for all patients.OS and PFS were calculated with Kaplan-Meier.The factors influencing OS and PFS were analyzed using Log-Rank test,and multivariate analysis was performed with Cox regression analysis.A consistency analysis of D-S staging and ISS staging was conducted using Kappa analysis.Results There was significant difference in PFS among patients with different ages （P〈0.05）.Significant difference in OS was observed among patients with different gender,age,lactate dehydrogenase,serum creatinine,ISS staging and efficacy （ P 〈0.05 ） .Cox regression analysis showed that age and efficacy had independent prognostic value for OS （P〈0.05）.There was a good consistency between D-S staging and ISS staging（Kappa=0.358,P〈0.001）.Conclusion Efficacy and age are the independent prognostic factors for OS in patients with MM,and age correlates with PFS.There is a good consistency between D-S staging and ISS staging,but ISS staging can evaluate the prognosis for patients with MM better.