Li Jing, Wang Yue, Liu Peng
Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China.
J Cancer. 2019 Aug 27;10(20):4807-4813. doi: 10.7150/jca.32103. eCollection 2019.
: Most multiple myeloma (MM) patients in China were diagnosed only until severe complications occurred. The incidence of MM in China is 7.3 times lower than that of the United States, which could have been underestimated due to high rate of miss diagnosis and diagnostic delay in China. In Zhongshan Hospital Fudan University, serum protein electrophoresis (SPEP) is routinely incorporated into liver function test panel, and therefore providing us unique opportunities to carry out a hospital-population-based M-protein screening by SPEP and establish a screening-driven diagnostic approach. : A retrospective cohort study analyzing data of patients screened by SPEP and diagnosed with MM from 2014 to 2017 was performed. We compared the baseline features and outcome of patients diagnosed via screen-driven approach and symptom-driven approach. We also analyzed the efficacy of M-protein screening. : A total of 690,000 people were screened and 335 eligible MM patients were identified, among which 151 of them were diagnosed via screening-driven approach. Compared to symptom-driven group, patients in screening-driven group had earlier ISS stage disease ( = 0.025), lower frequency of anemia ( = 0.000) and bone lesion ( = 0.012), and lesser number of end-stage symptoms ( = 0.000). M-protein screening approach demonstrated significantly ( = 0.029, HR: 0.415) better outcome (3-yr OS, 76.9%) than those in symptom-driven subgroup (3-yr OS, 46.6%) after being adjusted for age, gender, CRAB symptoms and ECOG score with a Cox proportional hazards model. Furthermore, the annual incidence of MM in Zhongshan Hospital screening population is 20.82/100,000, much higher than that in the whole China despite of selection bias. : We concluded that the actual MM incidence in China may have been underestimated and M-protein screening in hospital population by SPEP is an effective approach to improve early diagnosis rate and outcome.
在中国，大多数多发性骨髓瘤（MM）患者直到出现严重并发症才被诊断出来。中国MM的发病率比美国低7.3倍，由于中国误诊率高和诊断延迟，其发病率可能被低估。在复旦大学附属中山医院，血清蛋白电泳（SPEP）常规纳入肝功能检查项目，因此为我们提供了独特的机会，通过SPEP开展基于医院人群的M蛋白筛查，并建立筛查驱动的诊断方法。：进行了一项回顾性队列研究，分析2014年至2017年通过SPEP筛查并诊断为MM的患者数据。我们比较了通过筛查驱动方法和症状驱动方法诊断的患者的基线特征和结局。我们还分析了M蛋白筛查的效果。：共筛查69万人，确定335例符合条件的MM患者，其中151例通过筛查驱动方法诊断。与症状驱动组相比，筛查驱动组患者的国际分期系统（ISS）疾病分期更早（P = 0.025），贫血（P = 0.000）和骨病变（P = 0.012）的发生率更低，终末期症状的数量更少（P = 0.000）。在使用Cox比例风险模型对年龄、性别、CRAB症状和东部肿瘤协作组（ECOG）评分进行校正后，M蛋白筛查方法的结局（3年总生存率，76.9%）明显优于症状驱动亚组（3年总生存率，46.6%）（P = 0.029，风险比：0.415）。此外，尽管存在选择偏倚，中山医院筛查人群中MM的年发病率为20.82/10万，远高于全国发病率。：我们得出结论，中国MM的实际发病率可能被低估，通过SPEP对医院人群进行M蛋白筛查是提高早期诊断率和改善结局的有效方法。
