Li L, Jiang H, Fu W J, Du J, He H Y, Lu J, An R, He J, Zhang H, Zhao Y Y, Wu H, Hou J
Department of Hematology, The Myeloma & Lymphoma Center, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China.
Department of Hematology, The Myeloma & Lymphoma Center, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China; Department of Hematology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Zhonghua Xue Ye Xue Za Zhi. 2019 Apr 14;40(4):321-326. doi: 10.3760/cma.j.issn.0253-2727.2019.04.011.
To evaluate the prognostic value of serum free light chain ratio (rFLC) and difference (dFLC) in patients with multiple myeloma (MM) . Clinical data of 479 cases of newly diagnosed MM patients with FLC test records referred to our hospital from January 2012 to March 2016 were collected. rFLC preferred cut-off values were selected as≤14.828,14.828-364.597, ≥364.597 according to the literatures. The dFLC was divided into ≤112.85,112.85-2891.83, ≥2891.83 mg/L three groups. The rFLC and dFLC values among the death, the non-death, the progress and the non-progress groups were compared by test. The correlation analysis showed that the rFLC and dFLC values were related to the death or progression of the disease. Logistic regression was used to analyze the correlation between each factor and death or progression. Univariate survival analysis (PFS) and total survival (OS) were performed using Kaplan-Meier. Single-variable and multivariate prognostic analysis were performed using Cox model. The cutoff values of rFLC less than 14.828 or dFLC less than or equal to 112.85 mg/L impacted most significant on OS and PFS of the patients (<0.05) . Different rFLC cut-off values between two groups showed that when rFLC=14.828, OS was significantly better than the other two groups (NR 61 & 47 months, =0.019) ; different dFLC cut-off values between two groups disclosed that PFS and OS were statistically significant when dFLC less than or equal to 112.85 mg/L compared with the other two groups (<0.05) . The 4-year PFS/OS rates in the initial dFLC≤112.85 mg/L and rFLC≤14.828 groups was significantly higher than of the other two groups. Different cutoff levels of rFLC and dFLC might have obviously effects on the prognoses of patients with newly diagnosed MM. The difference of survival prognosis would be more pronounced when rFLC≤14.828 or dFLC≤112.85 mg/L with lower risk of death and lower risk ratio, which might be ideal cutoff value for determining the prognosis of these patients.
评估血清游离轻链比值（rFLC）和差值（dFLC）在多发性骨髓瘤（MM）患者中的预后价值。收集了2012年1月至2016年3月转诊至我院的479例有FLC检测记录的新诊断MM患者的临床资料。根据文献，rFLC的优选截断值选择为≤14.828、14.828 - 364.597、≥364.597。dFLC分为≤112.85、112.85 - 2891.83、≥2891.83 mg/L三组。通过检验比较死亡组、非死亡组、进展组和非进展组之间的rFLC和dFLC值。相关性分析表明，rFLC和dFLC值与疾病的死亡或进展相关。采用Logistic回归分析各因素与死亡或进展之间的相关性。使用Kaplan-Meier进行单因素生存分析（PFS）和总生存（OS）。使用Cox模型进行单变量和多变量预后分析。rFLC小于14.828或dFLC小于或等于112.85 mg/L的截断值对患者的OS和PFS影响最为显著（<0.05）。两组之间不同的rFLC截断值显示，当rFLC = 14.828时，OS显著优于其他两组（NR分别为61和47个月，=0.019）；两组之间不同的dFLC截断值表明，与其他两组相比，当dFLC小于或等于112.85 mg/L时，PFS和OS具有统计学意义（<0.05）。初始dFLC≤112.85 mg/L且rFLC≤14.828组的4年PFS/OS率显著高于其他两组。rFLC和dFLC的不同截断水平可能对新诊断MM患者的预后有明显影响。当rFLC≤14.828或dFLC≤112.85 mg/L时，生存预后差异更为明显，死亡风险和风险比更低，这可能是确定这些患者预后的理想截断值。
