CAJ | 학술논문

目的探讨国际分期体系(ISS)在我国多发性骨髓瘤(MM)患者中的适用性,并与Durie-Salmon(DS)分期、法国骨髓瘤工作组(IFM)分期进行比较.方法对112例具有ISS分期资料的MM初诊患者进行回顾性分析.结果 ①预后因素:血清β2微球蛋白(β2-MG)1≥3.5 mg/L是患者总体生存(OS)时间的独立预后不良因素,血清白蛋白(ALB)＜35g/L是患者疾病进展时间(TTP)的独立预后不良因素;在有核型检测结果的58例患者中,13号染色体异常(△13)是OS时间的唯一独立预后不良因素;②临床指标相关性:与血清β2-MG显著相关的因素有血清肌酐、24 h尿蛋白定量、体重指数(BMI)、体能分级(PS);与血清ALB显著相关的因素有血红蛋白浓度、骨髓浆细胞比例、乳酸脱氢酶(LDH)、发热、PS、M蛋白类型、血清磷、BMI;⑧ISS分期临床特征:除血清β2-MG和肌酐外,其他传统预后指标在Ⅱ、Ⅲ期间的差异无统计学意义;6例△13阳性患者中5例划入ISSⅡ期;④预后效能比较:ISS分期中Ⅰ、Ⅱ、Ⅲ期患者的中位OS时间分别为69、23和26个月,其中Ⅱ、Ⅲ期间差异无统计学意义;DS分期中89.5%的患者被归人Ⅲ期,Ⅰ、Ⅱ期与Ⅲ期间预后差异无统计学意义;IFM分期中低、中、高危三组患者的中位OS时间依次为69、40和8个月,其中低、中危组与高危组间差异有统计学意义.结论 ISS分期体系Ⅱ、Ⅲ期的划分似乎并不适用于中国MM患者;ISS、DS、IFM三个分期体系比较后发现纳入遗传学指标△13的IFM体系区分预后效能最佳.
목적 탐토국제분기체계(ISS)재아국다발성골수류(MM)환자중적괄용성,병여Durie-Salmon(DS)분기、법국골수류공작조(IFM)분기진행비교.방법 대112례구유ISS분기자료적MM초진환자진행회고성분석.결과 ①예후인소:혈청β2미구단백(β2-MG)1≥3.5 mg/L시환자총체생존(OS)시간적독립예후불량인소,혈청백단백(ALB)＜35g/L시환자질병진전시간(TTP)적독립예후불량인소;재유핵형검측결과 적58례환자중,13호염색체이상(△13)시OS시간적유일독립예후불량인소;②림상지표상관성:여혈청β2-MG현저상관적인소유혈청기항、24 h뇨단백정량、체중지수(BMI)、체능분급(PS);여혈청ALB현저상관적인소유혈홍단백농도、골수장세포비례、유산탈경매(LDH)、발열、PS、M단백류형、혈청린、BMI;⑧ISS분기림상특정:제혈청β2-MG화기항외,기타전통예후지표재Ⅱ、Ⅲ기간적차이무통계학의의;6례△13양성환자중5례화입ISSⅡ기;④예후효능비교:ISS분기중Ⅰ、Ⅱ、Ⅲ기환자적중위OS시간분별위69、23화26개월,기중Ⅱ、Ⅲ기간차이무통계학의의;DS분기중89.5%적환자피귀인Ⅲ기,Ⅰ、Ⅱ기여Ⅲ기간예후차이무통계학의의;IFM분기중저、중、고위삼조환자적중위OS시간의차위69、40화8개월,기중저、중위조여고위조간차이유통계학의의.결론 ISS분기체계Ⅱ、Ⅲ기적화분사호병불괄용우중국MM환자;ISS、DS、IFM삼개분기체계비교후발현납입유전학지표△13적IFM체계구분예후효능최가.
Objective To verify applicability of the International Staging System(ISS)for multiple myeloma(MM)to 112 Chinese MM patients and compare ISS with Durie-Salmon(DS)and Intergroup Francophone du Myelome(IFM)staging system in predicting prognosis.Methods 112 previously untreated MM patients in Blood Diseases Hospital of CAMS were analyzed according to ISS retrospectively.Results ①Serum β2-microglobulin(32-MG)≥3.5 mg/L was an independent adverse prognostic factor for overall survival(OS),and serum albumin＜35 g/L predicted for time to progression(TFP),②In the 58 cases having cytogenetic data,chromosome 13 aberration(△13)was the only independent adverse prognostic factor for OS:③ Factors significantly related to serum β2-MG were serum creatinine、24h urinary protein、body mass index(BMI)and performance status(PS);and those related to serum albumin were hemoglobin level、percentage of bone marrow plasma cells、lactate dehydrogenase(LDN)、fever、PS、class of M-protein、serum phosphorus and BMI;④All traditional prognostic factors had no statistical difference between ISS stage Ⅱ and Ⅲ excepting for serum β2-MG and creatinine,and 5/6 △13 patients were classified to ISS stageⅡ;⑤The median OS of ISS stage Ⅰ、Ⅱ、Ⅲ were 69、23 and 26 months(m)respectively,being no staffstical difference between stage Ⅱ and Ⅲ;for DS system,89.5% of patients were classified in stageⅢ,being no staftstical difference for OS between the stage Ⅰ/Ⅱand Ⅲ;while for IFM system,the median OS of low-、intermediate-and high-risk group were 69、40 and 8 months respectively,being statistically different between high-risk and interHiediate/low-risk groups.Conclusions From the result of our limited analysis,the staging of ISS Ⅱ and Ⅲ seems unsuitable for Chinese MM patients.The IFM staging system,which incorporates △13,is more effective than ISS、and DS staging system in predicting prognosis.