Comprehensive Cancer Center Amsterdam, PO Box 9236, 1006 AE Amsterdam, The Netherlands.
Eur J Cancer. 2010 Jan;46(1):160-9. doi: 10.1016/j.ejca.2009.07.006.
This study assesses whether new treatment strategies developed in clinical trials translate into improved survival for multiple myeloma (MM) patients in the Netherlands. All patients diagnosed with MM in the Northern part of the Netherlands between 1989 and 2005 were retrieved from two regional population-based cancer registries. Information on study participation was derived from linkage with trial information systems. The effect of period of diagnosis (1989-1992, 1993-1996, 1997-2000, 2001-2005), age (<50, 50-65, 66-74, 75), gender, Salmon-Durie (SD) stage, trial participation and treatment on relative survival were studied. In total 4985 patients were included. When trial participation was analysed for exact periods in which trials were open, 16% of patients aged 65 years with SD-stage I and 38% with SD-stage II or III were enrolled compared to 2% of patients aged >65 years with SD-stage I and 5% with SD-stage II or III. Relative survival decreased with age (p<.001), with advanced stage (p<.001) and was better for patients enrolled in trials (p<.001). Five-year relative survival increased from 34% (95% confidence interval (95% CI) 28-39%) in 1989-1992 to 56% (95% CI 50-61%) in 2001-2005 for patients 65 years. The excess mortality was 37% lower in 2001-2005 than in 1989-1992 for these patients, adjusted for age, stage, trial participation and gender (p<.001). Survival did not improve for older patients.
MM survival improved among younger but not among older patients since the mid-1990s. The improved survival of younger patients coincided with increasing trial participation and increasing use of high-dose chemotherapy and autologous stem-cell transplantation.
本研究评估了在临床试验中开发的新治疗策略是否能改善荷兰多发性骨髓瘤（MM）患者的生存。从两个区域性基于人群的癌症登记处中检索到了 1989 年至 2005 年间在荷兰北部诊断出 MM 的所有患者。研究参与情况的信息源自与试验信息系统的链接。研究了诊断期（1989-1992、1993-1996、1997-2000、2001-2005）、年龄（<50、50-65、66-74、75）、性别、Salmon-Durie（SD）分期、试验参与和治疗对相对生存率的影响。共纳入 4985 例患者。当分析试验参与的具体时间段时，与 65 岁以上 SD 分期 I 期和 38%SD 分期 II 或 III 期的患者相比，16%的患者参加了试验，而 65 岁以上 SD 分期 I 期和 5%SD 分期 II 或 III 期的患者仅为 2%。相对生存率随年龄增长而降低（p<.001），随分期进展而降低（p<.001），且参加试验的患者生存率更高（p<.001）。对于 65 岁的患者，1989-1992 年的五年相对生存率为 34%（95%置信区间（95%CI）为 28-39%），到 2001-2005 年增至 56%（95%CI 为 50-61%）。与 1989-1992 年相比，这些患者在 2001-2005 年的超额死亡率降低了 37%，调整年龄、分期、试验参与和性别因素后（p<.001）。对于年龄较大的患者，生存并未改善。
自 20 世纪 90 年代中期以来，年轻患者的 MM 生存率有所提高，但老年患者的生存率没有提高。年轻患者的生存改善与试验参与率增加以及大剂量化疗和自体干细胞移植的应用增加有关。
