全身磁共振成像多发性骨髓瘤浸润类型评估预后的价值

Evaluating Prognosis of Multiple Myeloma by Different Infiltrative Patterns on Whole-body MRI

目的探讨全身磁共振成像(WB-MRI)中多发性骨髓瘤(MM)病灶浸润类型评估患者预后的价值。资料与方法选择2010年1月—2016年12月经病理证实的62例MM患者,行WB-MRI检查前均未进行治疗,将患者WB-MRI病灶浸润类型分为正常型、小结节型、大结节型、混合型、弥漫型,比较不同病灶浸润类型对患者总生存期的影响。结果 62例患者中,正常型5例,小结节型20例,大结节型13例,混合型7例,弥漫型17例。所有患者均随访30.9~47.1个月,中位随访时间39个月,混合型患者的中位总生存期为17.0个月(95%CI 12.6~21.3个月),明显比其他浸润类型患者的中位总生存期43.0个月短(95%CI 33.7~52.3个月),差异有统计学意义(P<0.05)。此外,按DS和ISS分期系统评估初诊患者的肿瘤临床分期,其中DS I期6例,Ⅱ期6例,Ⅲ期50例;ISSⅠ期15例,Ⅱ期22例,Ⅲ期25例,WB-MRI病灶浸润类型与临床DS分期、ISS分期间无显著相关(P>0.05)。结论 WB-MRI中MM的不同浸润类型对评估患者预后有重要价值。

Purpose To investigate the prognostic value of whole-body magnetic resonance imaging（WB-MRI） for patients with multiple myeloma（MM）. Materials and Methods Sixty-two newly diagnosed patients with MM confirmed by pathology during January 2010 and December 2016 were enrolled in this study. The patients were divided into five groups according to the infiltrative patterns on MRI： normal pattern, micro-nodular pattern, macronodular pattern, mixed pattern and diffuse pattern, and their overall survival were compared. Results Of all the patients, micro-nodular infiltrative pattern was found in 20 patients, macro-nodular pattern in 13 patients, mixed pattern in 7 patients and diffuse pattern in 17 patients, while 5 patients were normal. During the follow-up for a median of 39 months（ranged 30.9-47.1 months）, overall survival with the mixed MM infiltrative pattern（median 17 months, 95% CI 12.6-21.3 months） was statistically shorter than those with other patterns（median 43 months, 95% CI 33.7-52.3 months; P〈0.05）. Additionally, the clinical DurieSalmon（DS） and International Staging System（ISS） were applied to evaluate the stage of MM patients. DS system showed that 6 patients were at stage I, another 6 patients were at stage Ⅱ and the other 50 patients were at stage Ⅲ. While based on ISS system, 15 patients were found at stage I, 22 patients were at stage Ⅱ and the rest 25 patients were at stage Ⅲ. Meanwhile, the correlation between the WB-MRI infiltrative patterns and DS system as well as ISS system had no significant correlation（P〉0.05）. Conclusion Different infiltrative patterns in WB-MRI can predict the prognosis in patients with MM at the time of diagnosis.