CAJ | 학술논문

目的探讨初诊时伴有髓外病变的多发性骨髓瘤(MM)患者的临床特点及影响预后的因素.方法回顾性分析2000年1月到2011年10月收治的46例初诊时伴髓外病变的MM患者(A组)的临床和病理特点、治疗效果、生存情况和影响预后的因素,以同时期收治的53例初诊时不伴发髓外病变的MM患者(B组)为对照.结果 A组与B组比较,β2微球蛋白(β2-MG)水平较高、溶骨性病变≥3处者多见(P =0.045、0.039).A组髓外病变最常见的受累部位依次为软组织、椎管内、肺部、胸膜、颅内及淋巴结.中位随访28(2 ～88)个月.A组治疗总有效率低于B组[58.5％ (24/41)比78.8％ (41/52),P=0.042]；预计中位总生存期低于B组(42.6个月比53.9个月,P=0.009).单因素分析显示初诊时溶骨性病变≥3处、血红蛋白≤110g/L、β2-MG≥5.5 mg/L、白蛋白≤30/L为A组患者的不良预后因素(均P＜ 0.05)；Cox回归多因素分析显示,溶骨性病变≥3处(OR=2.327,95％ CI:1.282 ～4.224)及β2-MG≥5.5 mg/L( OR =2.677,95％ CI:1.092 ～6.566)为影响A组患者总生存的独立不良预后因素.结论初诊的MM患者可多处并发髓外病变,这类患者总体疗效欠佳,预后不良,溶骨性病变≥3处及β2-MG≥5.5 mg/L为独立的不良预后因素.
목적 탐토초진시반유수외병변적다발성골수류(MM)환자적림상특점급영향예후적인소.방법 회고성분석2000년1월도2011년10월수치적46례초진시반수외병변적MM환자(A조)적림상화병리특점、치료효과、생존정황화영향예후적인소,이동시기수치적53례초진시불반발수외병변적MM환자(B조)위대조.결과 A조여B조비교,β2미구단백(β2-MG)수평교고、용골성병변≥3처자다견(P =0.045、0.039).A조수외병변최상견적수루부위의차위연조직、추관내、폐부、흉막、로내급림파결.중위수방28(2 ～88)개월.A조치료총유효솔저우B조[58.5％ (24/41)비78.8％ (41/52),P=0.042]；예계중위총생존기저우B조(42.6개월비53.9개월,P=0.009).단인소분석현시초진시용골성병변≥3처、혈홍단백≤110g/L、β2-MG≥5.5 mg/L、백단백≤30/L위A조환자적불량예후인소(균P＜ 0.05)；Cox회귀다인소분석현시,용골성병변≥3처(OR=2.327,95％ CI:1.282 ～4.224)급β2-MG≥5.5 mg/L( OR =2.677,95％ CI:1.092 ～6.566)위영향A조환자총생존적독립불량예후인소.결론 초진적MM환자가다처병발수외병변,저류환자총체료효흠가,예후불량,용골성병변≥3처급β2-MG≥5.5 mg/L위독립적불량예후인소.
Objective To explore the clinical features and prognostic factors of newly-diagnosed multiple myeloma ( MM ) with extramedullary ( EM ) involvements.Methods The clinical features,efficacies,survival rates and prognostic factors were retrospectively analyzed in 46 MM patients with EM (group A) from January 2000 to October 2011.And another 53 MM patients without EM (group B) were selected as the controls.Results The median age of Group A was 58 years.Compared with group B,the incidence of EM was associated with a higher level of β2-microglobulin ( β2-MG ) and extensive bone disease.The most common location of EM was soft tissues.And the total effective rates of groups A and B were 58.5％ (24/41) and 78.8％ (41/52) respectively.The difference was statistically significant ( P =0.042).The median follow-up time was 28 (2 -88) months.The estimated overall survival (OS) of the patients with EM was significantly shorter than those without EM (42.6 vs 53.9 months,P =0.009).Logrank univariate analysis showed that the number of osteolytic lesions ≥3,β2-MG≥5.5 mg/L,hemoglobin ≤110 g/L and albunin ≤30 g/L were poor prognostic factors in MM patients with EM. Multivariate analysis with Cox model showed only the number of osteolytic lesions ≥ 3 ( OR =2.327,95 ％ CI:1.282 - 4.224 ) and β2-MG≥ 5.5 mg/L ( OR =2.677,95％ CI:1.092 - 6.566 ) were statistically significant.Conclusions Multiple EM lesions may be involved in MM patients.For the patients with EM,the response to conventional chemotherapy is poor and the prognosis is unfavorable,especially for those with a high level of β2-MG or the number of osteolvtic lesions ≥ 3.