校正血钙与血清乳酸脱氢酶对初诊多发性骨髓瘤患者的预后价值

Prognostic Value of Corrected Levels of Serum Calcium and Serum Lactate Dehydrogenase for Newly Diagnosed Multiple Myeloma Patients

目的:探讨以经血清白蛋白校正后血清钙(校正血钙,cCA)水平和血清乳酸脱氢酶(LDH)水平,作为危险因素建立的风险分层对初诊多发性骨髓瘤(MM)患者的预后价值。方法:收集本院2015年6月1日至2017年11月1日收治的186例初诊MM患者的临床资料。对患者及家属进行电话随访及门诊就诊情况获得患者生存时间。回顾性分析由cCA水平及LDH水平组成的预后系统对MM患者生存时间的价值。以校正后高血钙和高LDH作为2个危险因素设计风险分层,将患者分为3组:第1组(无危险因素),第2组(1个危险因素)和第3组(2个危险因素),比较风险因素对MM患者预后的作用。结果:中位随访时间16个月。校正后高钙组累积生存率低于非高钙组,2组的1年累积OS率分别为79.0%±6.7%和88.6%±3.0%,3年累积OS率分别为53.0%±10.5%和74.6%±6.6%(P=0.016)。高LDH组[LDH>正常上限(ULN),ULN=250 U/L]累积生存率低于LDH正常组,2组的1年累积OS率分别为71.6%±8.6%和90.0%±2.8%,2年累积OS率分别为44.9%±12.1%和83.1%±4.0%,中位OS时间分别为19个月(95%CI:15.32-23.34)和未达到(P=0.001)。危险分组比较显示,第1组、第2组和第3组中位OS时间分别为未达到(n=103, 57%)、未达到(n=70, 39%)和17个月(n=7,4%,95%CI:5.19-28.41)(P<0.001)。有2种危险因素的患者预后比0-1个危险因素的患者差。结论:校正血钙和LDH水平的预后组合可以为临床实践中MM患者的风险分层和预后提供依据。

Objective:To investigate the prognostic value of the serum calcium level corrected by serum albumin(cCA)and corrected serum lactate dehydrogenase(LDH)level for the risk stratification for newly diagnosed multiple myeloma(MM)patients.Methods:The clinical data and survival of 186 newly diagnosed MM patients admitted to our hospital from June 1,2015 to November 1,2017 were collected.The patients’s survival time was obtained by telephone and follow-up visits to patients and their families.The value of the prognostic system consisting of cCA levels and LDH levels in the survival time of MM patients was retrospectively analyzed.Moreover,the post-corrected hypercalcemia and high LDH as 2 factors were used for risk stratification,then according to these 2 factors,the MM patients were divided into 3 groups:group 1(no risk factor),group 2(1 risk factor)and group 3(2 risk factors),and the effect of risk factors on the prognosis of MM patients was analyzed.Results:The median follow-up time was 16 months.The cumulative OS rate of the post-corrected hypercalcemia group was lower than that of the non-hypercalcemia group.The 1-year cumulative OS rate in the 2 groups was 79.0%±6.7%and 88.6%±3.0%,the 3-year cumulative OS rate was 53.0%±10.5%and74.6%±6.6%(P=0.016),respectively.The cumulative OS rate of the high LDH group[LDH>upper limit of normal(ULN),ULN=250 U/L]was lower than that in the normal LDH group.The 1-year cumulative OS rate in the 2 groups was 71.6%±8.6%and 90.0%±2.8%,the 2-year cumulative OS rate was 44.9%±12.1%and 83.1%±4.0%,respectively,and the median OS time was 19 months(95%CI:15.32-23.34)and not reached(P=0.001).The risk stratification analysis showed that the median OS time of the 3 group was not reached(n=103,57%),not reached(n=70,39%)and 17 months(n=7,4%,95%CI:5.19-28.41,P<0.001).Patients with two risk factors had a prognosis worse than patients with 0-1 risk factor.Conclusion:The prognostic combination of corrected serum calcium and LDH levels may provide a basis for risk stratification and prognosis in MM patients in clinical practice.