Chen Ying, Lairson David R, Chan Wenyaw, Du Xianglin L
Department of Epidemiology, Human Genetics, and Environmental Science, School of Public Health, University of Texas Health Science Center at Houston, 1200 Pressler Street, RAS-E631, Houston, TX, 77030, USA.
Department of Management Policy and Community Health, School of Public Health, University of Texas Health Science Center in Houston, Houston, TX, USA.
Med Oncol. 2017 Sep;34(9):153. doi: 10.1007/s12032-017-1001-7. Epub 2017 Aug 3.
The aim of this study was to examine whether novel agents proteasome inhibitor bortezomib and immunomodulatory drugs lenalidomide and thalidomide are effective in prolonging overall survival (OS) for patients with newly diagnosed multiple myeloma (MM) in the real-world practice setting. A nationwide and population-based retrospective cohort of elderly patients with advanced newly diagnosed MM from 2000 to 2009 were identified from the Surveillance, Epidemiology, and End Results-Medicare linked data. Survival was compared between cases in 2005-2009 and in 2000-2004, and between patients treated with anti-MM therapy and the untreated among cases in 2005-2009, using Cox proportional hazards models, Kaplan-Meier methods, and propensity score adjustment to further control for baseline confounding. Of 8839 patients, 4028 (45.6%) cases were in 2000-2004 and 4811 (54.4%) in 2005-2009. OS was significantly longer for patients in 2005-2009 than patients in 2000-2004 (27.9 vs. 20.0 months, P < 0.001). The hazard ratio for OS for cases in 2005-2009 compared with those in 2000-2004 was 0.78 (95% CI 0.74-0.82). Among 4811 cases in 2005-2009, 54% (n = 2587) received anti-MM therapy. Compared to those untreated, OS was significantly longer (41.1 vs. 27.9 months, P < 0.001) and hazard ratio was 0.58 (95% CI 0.54-0.62) in the treated patients. This study demonstrated improved survival in newly diagnosed MM patients in a more recent 5-year cohort compared with those in the previous 5 years. The survival benefit was significant across different demographic and patient characteristics. However, there were still a substantial number of MM patients not receiving anti-MM therapy.
本研究的目的是探讨新型药物蛋白酶体抑制剂硼替佐米以及免疫调节药物来那度胺和沙利度胺在实际临床环境中，对于新诊断的多发性骨髓瘤（MM）患者延长总生存期（OS）是否有效。通过监测、流行病学及最终结果-医疗保险链接数据，确定了一个基于全国人口的2000年至2009年老年晚期新诊断MM患者的回顾性队列。使用Cox比例风险模型、Kaplan-Meier方法以及倾向得分调整来进一步控制基线混杂因素，比较了2005 - 2009年和2000 - 2004年病例之间的生存率，以及2005 - 2009年病例中接受抗MM治疗患者和未接受治疗患者之间的生存率。在8839例患者中，4028例（45.6%）病例在2000 - 2004年，4811例（54.4%）在2005 - 2009年。2005 - 2009年患者的总生存期显著长于2000 - 2004年患者（27.9个月对20.0个月，P < 0.001）。2005 - 2009年病例与2000 - 2004年病例相比，总生存期的风险比为0.78（95%CI 0.74 - 0.82）。在2005 - 2009年的4811例病例中，54%（n = 2587）接受了抗MM治疗。与未接受治疗的患者相比，接受治疗患者的总生存期显著更长（41.1个月对27.9个月，P < 0.001），风险比为0.58（95%CI 0.54 - 0.62）。本研究表明，与前5年相比，新诊断MM患者在更近的5年队列中的生存率有所提高。在不同的人口统计学和患者特征中，生存获益均显著。然而，仍有相当数量的MM患者未接受抗MM治疗。
