多发性骨髓瘤患者骨髓细胞形态学指标与临床分期、预后的关系

Relationship of cell morphology indicators with clinical staging and prognosis in patients with multiple myeloma

目的探究多发性骨髓瘤(MM)患者细胞形态学指标与临床分期、预后的关系。方法回顾性分析2017年12月至2020年12月于聊城市第三人民医院就诊的82例MM患者的临床资料,根据骨髓瘤国际分期标准(ISS)将其分为早期组(ISS分期Ⅰ期者)和中晚期组(ISS分期Ⅱ~Ⅲ期者)。比较早期组和中晚期组骨髓细胞形态学指标(原始浆细胞占比、幼稚浆细胞占比、成熟浆细胞占比),采用受试者工作特征曲线分析上述指标对中晚期MM的诊断效能。根据患者治疗1年内预后转归情况分为预后不良组(死亡、远端转移或病情恶化)和预后良好组(病情稳定无进展),比较两组骨髓细胞形态学指标,采用受试者工作特征曲线分析上述指标对MM预后不良的预测效能。结果中晚期组原始浆细胞占比、幼稚浆细胞占比高于早期组(P<0.05),两组成熟浆细胞占比比较差异未见统计学意义(P>0.05)。受试者工作特征曲线分析结果显示,原始浆细胞占比、幼稚浆细胞占比、成熟浆细胞占比诊断中晚期MM的曲线下面积分别为0.861、0.793、0.533,截断值分别为27.12%、27.03%、14.39%,原始浆细胞占比及幼稚浆细胞占比的诊断效能良好(P<0.05)。预后不良组原始浆细胞占比、幼稚浆细胞占比高于预后良好组(P<0.05),两组成熟浆细胞占比比较差异未见统计学意义(P>0.05)。受试者工作特征曲线分析结果显示,原始浆细胞占比、幼稚浆细胞占比、成熟浆细胞占比预测MM患者预后不良的曲线下面积分别为0.848、0.787、0.536,截断值分别为29.10%、23.80%、13.91%,原始浆细胞占比及幼稚浆细胞占比预测效能良好(P<0.05)。结论不同临床分期、预后转归的MM患者细胞形态学存在一定差异,其中原始浆细胞占比、幼稚浆细胞占比等指标可为临床中MM患者临床分期评估、预后预测提供参考。

Objective To investigate the relationship of cell morphology indicators with clinical staging and prognosis in patients with multiple myeloma(MM).Methods The clinical data of 82 patients with MM who were treated in Liaocheng Third People’s Hospital from December 2017 to December 2020 were retrospectively analyzed.According to the International Staging Standard for Myeloma(ISS),the patients were divided into early stage group(ISS stage I)and middle-advanced stage group(ISS stageⅡ-Ⅲ).The bone marrow cell morphological indicators(proportion of primordial plasma cells,proportion of immature plasma cells,proportion of mature plasma cells)were compared between early stage group and middle-advanced stage group.Receiver operating characteristic curve was used to analyze the diagnostic efficiency of the above indicators on middle-to-advanced MM.According to the prognosis and outcomes of patients within 1 year after treatment,the patients were classified into poor prognosis group(death,with distant metastasis or disease deterioration)and good prognosis group(stable disease without progression).The morphological indicators of bone marrow cells of the poor and good prognosis groups were compared,and receiver operating characteristic curve was adopted to analyze the predictive efficiency of the above indicators on poor prognosis of MM.Results The proportion of primordial plasma cells and proportion of immature plasma cells were in middle-advanced stage group significantly higher than those in early stage group(P<0.05),but there was no significant difference in the proportion of mature plasma cells between the two groups(P>0.05).Results of receiver operating characteristic curve showed that the area under curve of the above indicators for diagnosing middle-advanced MM were 0.861,0.793 and 0.533,respectively,and the cut-off values were 27.12%,27.03%and 14.39%,suggesting the proportion of primordial plasma cells and the proportion of immature plasma cells had good diagnostic efficiency(P<0.05).The proportion of primordial plasma cells and immature plasma cells in poor prognosis group were significantly higher than those in good prognosis group(P<0.05),but there was no significant difference in the proportion of mature plasma cells between the two groups(P>0.05).Results of receiver operating characteristic curve showed that the area under curve of the above indicators were 0.848,0.787 and 0.536,respectively in predicting poor prognosis of patients with MM,and the cut-off values were 29.10%,23.80%and 13.91%,respectively,suggesting the proportion of primordial plasma cells and immature plasma cells had good predictive efficiency(P<0.05).Conclusions There are some differences in the cell morphology of patients with MM of different clinical stages and prognoses.The proportion of primordial plasma cells and proportion of immature plasma cells can provide reference value for clinical staging evaluation and prognosis prediction of patients with MM.