摘要
目的:探讨修订的国际分期系统(R-ISS)对初诊多发性骨髓瘤(MM)的预后价值。方法:对189例初诊的MM患者进行FISH或cIg-FISH检测细胞遗传学异常,并统计疾病分期及生存情况。结果:t(4;14)阳性者24例(13.5%,24/178),del(17p)阳性者20例(10.7%,20/187)。对比阴性患者,t(4;14)及del(17p)阳性患者具有较短的中位无进展生存(PFS),差异有统计学意义(P<0.05),而中位总生存(OS)差异无统计学意义,但t(4;14)阳性患者与阴性患者生存曲线有分离趋势。t(14;16)阳性患者仅5例,未单独分析。多因素分析显示,年龄、乳酸脱氢酶(LDH)和del(17p)是评估OS的独立预后因素(P<0.05);LDH、del(17p)和t(4;14)是评估PFS的独立预后因素(P<0.05)。R-ISS分期Ⅰ、Ⅱ和Ⅲ期患者分别为16、142和31例,1年OS率分别为100%、89%和65%(P<0.001),1年PFS率分别为86%、77%和52%(P=0.002);ISS分期Ⅰ、Ⅱ、Ⅲ期患者分别为23、77和89例,1年OS率分别为90%、88%和83%(P=0.239),1年PFS率分别为72%、73%和74%(P=0.672)。结论:t(4;14)、del(17p)核型异常及LDH均是预后不良因素;基于LDH和细胞遗传学异常基础上的R-ISS分期在初诊MM患者的预后评估中优于ISS分期系统。
Objective:To investigate the prognostic value of revised international staging system(R-ISS)in newly diagnosed multiple myeloma(MM)patients.Method:A total of 189 patients with newly diagnosed MM were enrolled.The cytogenetic abnormalities were detected by iFISH or cIg-FISH.R-ISS and ISS staging were performed on all the patients and the clinical outcome was analyzed.Result:t(4;14)positive patients were 24 cases(13.5%),del(17 p)positive patients were 20 cases(10.7%).Patients with t(4;14)or del(17 p)positive had a significant shorter PFS than those negative(P〈0.05).Although there was no significant difference in OS between patients with or without these two cytogenetic abnormalities,patients with t(4;14)positive had longer survival time.Only 5 patients were t(14;16)positive,a separate analysis was not performed.Multivariate analysis by COX regression showed that age,LDH and del(17 p)were independent prognostic factors for OS(P〈0.05).LDH,del(17 p)and t(4;14)were independent prognostic factors for PFS(P〈0.05).Patients withⅠ,Ⅱ,Ⅲstage in R-ISS staging were 16,142 and 31 cases,and 1-year OS were 100%,89% and 65%(P〈0.001),1-year PFS were 86%,77% and 52%(P=0.002).Patients with Ⅰ,Ⅱ,Ⅲ stage in ISS staging were 23,77 and 89 cases,and 1-year OS were 90%,88%and 83%(P=0.239),1-year PFS were 72%,73%and 74%(P=0.672).Conclusion:Cytogenetic abnormalities and LDH are predictive factors for poor prognosis;R-ISS staging based on LDH and cytogenetic abnormalities is superior to the ISS staging system in the prognostic evaluation of newly diagnosed MM patients.
作者
史青林
顾炎
沈旭星
郭睿
屈晓燕
许戟
李建勇
陈丽娟
SHI Qinglin;GU Yan;SHEN Xuxing;GUO Rui;QU Xiaoyan;XU Ji;LI Jianyong;CHEN Lijuan(Department of Hematology,the First Affiliated Hospital of Nanjing Medical University, Nan- jing, 210029, China)
出处
《临床血液学杂志》
CAS
2018年第3期359-364,共6页
Journal of Clinical Hematology
基金
国家自然科学基金(No:81372540、81670199)
江苏省医学重点人才(No:ZDRCA2016015)
国家临床重点专科建设项目
江苏省科教强卫工程医学重点学科