Kim Dae Sik, Yu Eun Sang, Kang Ka-Won, Lee Se Ryeon, Park Yong, Sung Hwa Jung, Choi Chul Won, Kim Byung Soo
Division of Oncology and Hematology, Department of Internal Medicine, Korea University School of Medicine, Seoul, Korea.
Korean J Intern Med. 2017 Jul;32(4):711-721. doi: 10.3904/kjim.2016.054. Epub 2016 Nov 4.
BACKGROUND/AIMS: The aims of this study were to identify the value of inflammatory markers as pretreatment prognostic factors for patients with multiple myeloma (MM) and to estimate the value of a prognostic index including these markers at diagnosis.
A total of 273 newly diagnosed MM patients undergoing active treatment were analyzed in this study. The prognostic values for survival of the pretreatment inflammatory markers were investigated. A myeloma prognostic index (MPI) was derived using prognostic factors determined to be independently significant on multivariate analysis.
A high pretreatment neutrophil-lymphocyte ratio (NLR), low platelet count, and high C-reactive protein (CRP) level had independently unfavorable significance for overall survival (OS). The MPI was derived based on these factors. Per the MPI, 1 point each was assigned to high NLR, low platelet count, and high CRP. Risk categories were stratified into low- (score 0), intermediate- (score 1), and high-risk (score 2 or 3) groups. The MPI demonstrated independent statistical significance for OS on multivariate analysis ([intermediate: hazard ratio (HR), 1.91; 95% confidence interval (CI), 1.12 to 3.24] and [high: HR, 3.37; 95% CI, 2.00 to 5.69]; < 0.001). Moreover, this significance could be observed regardless of age, renal function, and exposure to novel agents. In addition, the International Staging System risk group could be further significantly stratified using the MPI.
The MPI, consisting of pretreatment inflammatory markers, NLR, platelet count, and CRP, might be effective in predicting the survival of newly diagnosed MM patients undergoing active treatment.
背景/目的：本研究旨在确定炎症标志物作为多发性骨髓瘤（MM）患者预处理预后因素的价值，并评估包含这些标志物的预后指数在诊断时的价值。
本研究分析了273例接受积极治疗的新诊断MM患者。研究了预处理炎症标志物对生存的预后价值。使用多变量分析确定的独立显著预后因素得出骨髓瘤预后指数（MPI）。
预处理时高中性粒细胞与淋巴细胞比值（NLR）、低血小板计数和高C反应蛋白（CRP）水平对总生存期（OS）具有独立的不利意义。基于这些因素得出MPI。根据MPI，高NLR、低血小板计数和高CRP各得1分。风险类别分为低风险（评分0）、中风险（评分1）和高风险（评分2或3）组。MPI在多变量分析中对OS显示出独立的统计学意义（[中风险：风险比（HR），1.91；95%置信区间（CI），1.12至3.24]和[高风险：HR，3.37；95%CI，2.00至5.69]；<0.001）。此外，无论年龄、肾功能和新型药物暴露情况如何，均可观察到这种意义。此外，使用MPI可进一步显著分层国际分期系统风险组。
由预处理炎症标志物、NLR、血小板计数和CRP组成的MPI可能有助于预测接受积极治疗的新诊断MM患者的生存期。
