修订的国际分期系统对初诊多发性骨髓瘤的预后意义

The prognostic value of the revised international staging system for newly diagnosed multiple myeloma

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.