多发性骨髓瘤伴发第二肿瘤与恶性肿瘤伴发多发性骨髓瘤的临床特征分析

Clinical analysis of multiple myeloma with second primary malignancies and multiple myeloma secondary to malignancies

目的分析多发性骨髓瘤(MM)患者伴发第二肿瘤与其他恶性肿瘤伴发MM的患者的临床特征及生存转归。方法纳入2002年1月至2021年1月首都医科大学附属北京朝阳医院诊治的MM患者的临床资料,将患者分为MM伴发第二肿瘤组以及恶性肿瘤伴发MM组。分析两组患者性别、初诊年龄、分型、分期、合并恶性肿瘤类型以及治疗情况,比较两组患者的临床特征和生存差异。结果MM伴发第二肿瘤组患者20例,其中男9例,女11例,年龄[M(Q_(1),Q_(3))]61.5(56.8,68.0)岁,总生存期49.5(32,58)个月,自伴发第二肿瘤至死亡的时间12(4,21)个月。恶性肿瘤伴发MM组患者29例,其中男13例,女16例,年龄64.0(57.0,71.0)岁,总生存期97(61,171)个月,伴发MM后至死亡的时间32(18,47)个月。诊断MM至发生第二肿瘤时间为37(18,50)个月,早于其他恶性肿瘤伴发MM时间[53(31,117)个月](P=0.016)。两组发生的其他恶性肿瘤类型不同,MM伴发第二肿瘤组中第二肿瘤占比高的是血液系统肿瘤(12/20,60.0%),而恶性肿瘤伴发MM组中泌尿生殖系统肿瘤占比较高(13/29,44.8%)(P<0.001)。结论MM伴发第二肿瘤或恶性肿瘤伴发MM均可能对患者的生存期造成负面影响;MM患者出现的第二肿瘤中血液系统肿瘤占比较高,而在伴发MM的恶性肿瘤中以泌尿生殖系统肿瘤占比较高。

Objective To compare the clinical characteristics and survival outcomes of multiple myeloma(MM)with second primary malignancies(SPMs)and MM secondary to malignancies.Methods The clinical data of MM patients diagnosed and treated in Beijing Chaoyang Hospital,Capital Medical University from January 2002 to January 2021 were included.The patients were divided into two groups:MM with SPMs group and MM secondary to malignancies group.The gender,age at first diagnosis,classification,stage,type of combined malignant tumor and the treatment were analyzed.The clinical characteristics and survival differences were compared between the two groups.Results There were 20 patients in the MM with SPMs group,9 males and 11 females,aged[M(Q_(1),Q_(3))]61.5(56.8,68.0)years,and the overall survival(OS)was 49.5(32,58)months,while the time to death from secondary tumor was 12(4,21)months.There were 29 patients in the MM secondary to malignancies group,13 males and 16 females,aged 64.0(57.0,71.0)years,and the OS was 97(61,171)months,while the time to death from secondary MM was 32(18,47)months.The time from patients diagnosed with MM to SPMs was 37(18,50)months,which was significantly earlier than that of MM secondary to malignancies[53(31,117)months](P=0.016).The type of tumor was also different between the two groups(P<0.001).In the group of MM with SPMs,the most common type of SPMs was hematopoietic malignancies(12/20,60.0%),whereas in the group of MM secondary to malignancies,MM was most often secondary to genitourinary malignancies(13/29,44.8%)(P<0.001).Conclusions Both MM with SPMs and MM secondary to malignancies can affect the survival of patients.Secondary hematological malignancies account for a high proportion of the second tumors in MM patients,while genitourinary malignancies account for a high proportion of malignant tumors associated with MM.