淋巴细胞/单核细胞比率与校正血钙作为新诊断多发性骨髓瘤预后标志物的意义

Significance of Lymphocyte-to-Monocyte Ratio and Corrected Levels of Serum Calcium as Prognostic Markers in Patients with Newly Diagnosed Multiple Myeloma

目的:探讨外周血淋巴细胞与单核细胞比率(LMR)和校正后血清钙(c Ca)作为新诊断多发性骨髓瘤(MM)患者预后标志物的意义。方法:回顾性分析2013年1月至2020年3月昆明医科大学第二附属医院114例初诊MM患者的临床资料,采用ROC曲线确定变量的最佳临界值,将患者划分为高LMR和低LMR(LMR≥3.35和LMR<3.35)两组,根据初诊及4个疗程治疗的LMR(LMR4)将患者分为A(LMR≥3.35,LMR4≥3.35)、B(LMR≥3.35,LMR4<3.35)、C(LMR<3.35,LMR4≥3.35)和D(LMR<3.35,LMR4<3.35)这4组。结合LMR和c Ca制定简易预后模型,将患者划分为a(无危险因素)、b(1个危险因素)和c(2个危险因素)这3组。采用独立样本t检验和Pearson卡方检验或Mann-Whitney U检验评估各种参数的差异性,Kaplan-Meier法及Cox回归进行生存分析。结果:中位随访时间13.05(0.1-72.5)个月。生存分析显示,初诊时较低的LMR能够预示更差的结局,其中低LMR组与高LMR组比较,总体生存时间(OS)明显缩短(17 vs 50.5个月,P=0.006)。同样可以观察到A与D组之间OS的差异(56.5 vs 30.5个月,P=0.043),高c Ca(≥2.75 mmol/L)组与正常组比较,OS也明显缩短(8.5 vs 34个月,P=0.006)。多因素生存分析显示,LMR<3.35(P=0.028)和c Ca≥2.75 mmol/L(P=0.036)是MM患者的独立预后因素,危险因素分组比较显示,a、b及c组中位OS分别为50、20和8.5个月,无危险因素者预后均优于合并1-2个危险因素者(a vs b组,P<0.0001;a vs c组,P=0.002)。结论:对于初诊MM患者,LMR和c Ca是影响预后的独立风险因素,结合两者制定简易预后系统能够快速判断初诊MM患者的预后。

Objective:To investigate the significance of peripheral blood lymphocyte to monocyte ratio(LMR) and corrected levels of serum calcium(cCa) as prognostic markers for the newly diagnosed multiple myeloma(MM) patients.Methods:The clinical data of 114 newly diagnosed MM patients in the Second Affiliated Hospital of Kunming Medical University from January 2013 to March 2020 were retrospectively analyzed.Receiver operating characteristic(ROC)curve analysis was used to identify the optimal cutoff value,and the patients were divided into high LMR group and low LMR group(LMR≥ 3.35 and LMR <3.35).Moreover,the patients were divided into four groups according to initial diagnosis LMR and LMR after four courses of treatment(LMR4):Group A(LMR≥3.35,LMR4≥3.35),Group B(LMR≥3.35,LMR4 <3.35),Group C(LMR <3.35,LMR4≥3.35),and group D(LMR <3.35,LMR4 <3.35).The simple prognosis model was established by combined with LMR and cCa,the patients were divided into Group a(no risk factor),group b(1 risk factor) and Group c(2 risk factors).Independent sample T-test,Pearson Chi-square test or Mann-Whitney U test were used to evaluate the differences between various parameters,and Kaplan-Meier method and Cox regression were used for survival analysis.Results:The median follow-up time was 13.05(0.1-72.5) months.Survival analysis showed that the patients with low LMR predicted poor prognosis,the overall survival(OS) time of the patients with low LMR was significantly shorter(17 vs 50.5 months,P=0.006) than the patients with high LMR,the difference was also significant between group A and Group D(56.5 vs 30.5 months,P=0.043).The OS of the patients was also significantly shorter in the high cCa group(≥2.75 mmol/L) compared with normal group(8.5 vs 34 months,P=0.006).Multivariate survival analysis showed that LMR <3.35(P=0.028) and cCa≥2.75 mmol/L(P=0.036) were the independent risk factors affecting prognosis of MM patients.The comparison of risk factors showed that the median OS of Group a,b and c was 50,20,and 8.5 months,respectively.The prognosis of the patients without risk factors was better than that of patients with 1-2 risk factors(Group a vs Group b,P <0.0001;Group a vs Group c,P=0.002).Conclusion:LMR and cCa are the independent risk factors affecting the prognosis of newly diagnosed MM patients,and the development of a simple prognosis system combining them can quickly identify the prognosis of newly diagnosed MM patients.