Scudla V, Zemanova M, Minarik J, Bacovsky J, Ordeltova M, Indrak K, Budikova M, Dusek L, Farbiakova V
3rd Department of Internal Medicine, Faculty Hospital, Medical Faculty of Palacky University, Olomouc, 77520 Czech Republic.
Neoplasma. 2006;53(4):277-84.
In the group of 270 patients with multiple myeloma (MM) treated during 1991-2004 by conventional chemotherapy, the prognostic value and practical utility of IPI (International Prognostic Index) was assessed and compared with five other actual staging systems. Prognostic significance was assessed using the curves of overall survival (OS) according to Kaplan-Meier and log rank test (p<0.05). Good practical utility and prognostic significance of Durie-Salmon (D-S) system was confirmed (p<0.001). Good overall prognostic significance was observed in simple staging systems based on the measurement of beta2-microglobulin and albumin serum levels according to Bataille (p<0.001), SWOG (South West Oncology Group, p<0.001) and IPI (p<0.001). Regardless of a short 5-year duration of the study, the scoring system according to San Miguel enclosing apart from other parameters also propidium iodide proliferation index (PC-PI) of myeloma plasmocytes seems to be promising with very different characteristics of curves of overall survival (p<0.001). Very good prognostic value and easy practical utility were examined in Olomouc staging system (OSS) based on the measurement of beta2-microglobulin and thymidinekinase serum levels (p<0.001). With regard to detection of patients of stage 1, i. e. "low risk", not requiring an immediate initiation of conventional chemotherapy ("wait and see" approach), the most suitable was the system according to D-S, SWOG and IPI (median OS 77, 76 and 77 months). To select a cohort of "high risk" patients, i.e. stage 3, with very unfavourable disease prognosis, the most advantageous was the system OSS and San Miguel (median OS was 5 and 6 months) and/or SWOG system selecting patients of stage 4, i.e. "worst prognosis", with median OS 8 months. It was found that IPI did not meet expectations for effective identification of "high risk" patients (median OS of stage 3 was 20 months) nor for the distinction of different prognosis of patients during initial 25 months of MM course at stage 2 vs. 3. The study indicates that under conditions of common clinical practice and conventional chemotherapy, the staging system according to D-S is still useful, while practical application of SWOG and IPI as simpler alternative to the assessment of clinical stage should be verified by further comparative studies. In harmony with the progress in cytogenetics and molecular biology as well as a prospective requirement of individual target therapy, a future suitable stratification system should be based on parameters of internal biological properties of myeloma tissue and microenvironment of bone marrow, allowing in addition a continuous evaluation of the disease course and the effect of therapy.
在1991年至2004年期间接受传统化疗的270例多发性骨髓瘤（MM）患者组中，评估了国际预后指数（IPI）的预后价值和实际效用，并与其他五个实际分期系统进行了比较。使用根据Kaplan-Meier法绘制的总生存（OS）曲线和对数秩检验评估预后意义（p<0.05）。Durie-Salmon（D-S）系统具有良好的实际效用和预后意义得到了证实（p<0.001）。根据Bataille（p<0.001）、西南肿瘤协作组（SWOG，p<0.001）和IPI（p<0.001）基于β2-微球蛋白和血清白蛋白水平测量的简单分期系统具有良好的总体预后意义。尽管该研究为期5年较短，但圣米格尔评分系统除其他参数外还纳入了骨髓瘤浆细胞的碘化丙啶增殖指数（PC-PI），其总生存曲线特征差异很大，似乎很有前景（p<0.001）。基于β2-微球蛋白和胸苷激酶血清水平测量的奥洛穆茨分期系统（OSS）具有非常好的预后价值且易于实际应用（p<0.001）。关于检测1期患者，即“低风险”患者，不需要立即开始传统化疗（“观察等待”方法），最合适的是D-S、SWOG和IPI系统（中位OS分别为77、76和77个月）。为了选择一组“高风险”患者，即3期患者，其疾病预后非常不利，最有利的是OSS和圣米格尔系统（中位OS分别为5和6个月）和/或SWOG系统选择4期患者，即“预后最差”患者，中位OS为8个月。发现IPI未达到有效识别“高风险”患者的预期（3期患者的中位OS为20个月），也未达到区分MM病程初始25个月期间2期与3期患者不同预后的预期。该研究表明，在普通临床实践和传统化疗条件下，D-S分期系统仍然有用，而SWOG和IPI作为临床分期评估的更简单替代方法的实际应用应通过进一步的比较研究来验证。随着细胞遗传学和分子生物学的进展以及个体化靶向治疗的前瞻性要求，未来合适的分层系统应基于骨髓瘤组织的内部生物学特性和骨髓微环境参数，此外还应允许对疾病进程和治疗效果进行持续评估。
