Barosi G, Berzuini C, Liberato L N, Costa A, Polino G, Ascari E
Dipartimento di Medicina Interna e Terapia Medica (Sez. Clinica Medica II), Università di Pavia, Italy.
Br J Haematol. 1988 Dec;70(4):397-401. doi: 10.1111/j.1365-2141.1988.tb02507.x.
The dependence of survival time on a set of prognostic factors was explored by means of Cox's regression model in 137 cases of myelofibrosis with myeloid metaplasia (MMM). The following parameters recorded at diagnosis proved to be important independent indicators of a poor prognosis: a higher value for age, a lower value for Hb concentration, a higher value for immature myeloid cells in peripheral blood (IMC), a lower value for total erythroid iron turnover (TEIT), and a bone marrow red cell aplasia (RCA). A prognostic classification tree was constructed whose terminal nodes (risk groups), described by simple logical conditions upon important indicators, were characterized by significantly different expected survival. The two extreme risk groups lend themselves to a simple, but complete description. The low-risk group (19.7% of the sample) comprises cases who had the diagnosis of MMM before age 45 and a number of IMC constantly lower than 24%. The actuarial proportion of patients surviving at 15 years was 100%. The high-risk group (29.9% of cases) comprises patients with age greater than 45 and Hb lower than 13 g/dl, associated with RCA, or with a relatively decreased erythropoiesis (TEIT lower than 2 times the normal) or with IMC greater than 24%. Seven out of the 11 who died within this group developed blastic crisis. Median survival time of the group was 69 months.
采用Cox回归模型，对137例骨髓纤维化伴髓外化生（MMM）患者的生存时间与一组预后因素的相关性进行了研究。诊断时记录的以下参数被证明是预后不良的重要独立指标：年龄较高、血红蛋白（Hb）浓度较低、外周血幼稚髓细胞（IMC）数量较高、总红细胞铁周转率（TEIT）较低以及骨髓红细胞再生障碍（RCA）。构建了一个预后分类树，其终端节点（风险组）由重要指标的简单逻辑条件描述，其预期生存率有显著差异。两个极端风险组易于进行简单而完整的描述。低风险组（占样本的19.7%）包括45岁前诊断为MMM且IMC数量持续低于24%的患者。15年存活患者的精算比例为100%。高风险组（占病例的29.9%）包括年龄大于45岁且Hb低于13 g/dl、伴有RCA、或红细胞生成相对减少（TEIT低于正常水平的2倍）或IMC大于24%的患者。该组中死亡的11例患者中有7例发生了原始细胞危象。该组的中位生存时间为69个月。
