Jacobson Joth L, Hussein Mohamad A, Barlogie Bart, Durie Brian G M, Crowley John J
Southwest Oncology Group Statistical Center, Seattle, WA 98101-1468, USA.
Br J Haematol. 2003 Aug;122(3):441-50. doi: 10.1046/j.1365-2141.2003.04456.x.
We aimed to develop and evaluate a staging system for multiple myeloma (MM) based on easily obtained laboratory measures. The Durie-Salmon stage is most commonly used and is an effective system of patient stratification for clinical trial research. However, the criteria are complex and many laboratory parameters are required to properly stage patients. In this analysis, we focused on two common measures with prognostic importance in MM: serum beta2 microglobulin (beta2m) and serum albumin. Pre-study data on 1555 previously untreated MM patients enrolled on four recent South-west Oncology Group (SWOG) phase III trials were used in the analysis. Staging models were developed and validated using regression tree methods for survival outcomes. SWOG stages were defined as: stage 1, beta2m < 2.5 mg/l (14% of patients, median overall survival of 55 months); stage 2, 2.5 </= beta2m < 5.5 (43% of patients, median overall survival of 40 months); stage 3, beta2m >/= 5.5 and albumin >/= 30 g/l (32% of patients, median overall survival of 24 months); and stage 4, beta2m >/= 5.5 and albumin < 30 g/l (11% of patients and median overall survival of 16 months). This staging scheme was also predictive of event-free survival, first-year mortality and long-term (>/= 5 years) event-free survival. We conclude that although the SWOG stage does not represent a new prognostic marker for MM (cytogenetics, FISH), it could provide a simple alternative to the Durie-Salmon stage for patients with previously untreated MM. Additional evaluation in other MM patient populations is needed to confirm results.
我们旨在基于易于获得的实验室检测指标，开发并评估一种用于多发性骨髓瘤（MM）的分期系统。Durie-Salmon分期是最常用的，并且是用于临床试验研究的有效的患者分层系统。然而，其标准复杂，正确对患者进行分期需要许多实验室参数。在本分析中，我们重点关注了在MM中具有预后重要性的两项常见检测指标：血清β2微球蛋白（β2m）和血清白蛋白。分析使用了1555例先前未接受治疗的MM患者的研究前数据，这些患者入组了最近的四项西南肿瘤协作组（SWOG）III期试验。使用回归树方法针对生存结局开发并验证了分期模型。SWOG分期定义为：1期，β2m＜2.5mg/l（占患者的14%，中位总生存期为55个月）；2期，2.5≤β2m＜5.5（占患者的43%，中位总生存期为40个月）；3期，β2m≥5.5且白蛋白≥30g/l（占患者的32%，中位总生存期为24个月）；4期，β2m≥5.5且白蛋白＜30g/l（占患者的11%，中位总生存期为16个月）。该分期方案对无事件生存期、第一年死亡率和长期（≥5年）无事件生存期也具有预测性。我们得出结论，尽管SWOG分期并不代表MM的新预后标志物（细胞遗传学、荧光原位杂交），但对于先前未接受治疗的MM患者，它可以为Durie-Salmon分期提供一种简单的替代方案。需要在其他MM患者群体中进行额外评估以证实结果。
