Hu Li-Na, Liu Yi, Dan Gang, Liu Yi-Lan
Department of Laboratorial, Western Theater General Hospital of People's Liberation Army, Chengdu 610083, Sichuan Province, China.
Medical Technology College of Chongqing Medical College, Chongqing 401331, China,E-mail：
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2020 Oct;28(5):1611-1617. doi: 10.19746/j.cnki.issn.1009-2137.2020.05.030.
To investigate the influence of rFLC and dFLC on clinical prognosis and best cutoff value in patients with newly diagnosed multiple myelome(MM).
Clinical data of 240 patients with newly diagnosed MM treated in Western Theater General Hospital of People's Liberation Army from January 2010 to June 2016 were collected and retroanalyzed. All patients were divided into different groups according to the interquartile spacing levels of rFLC and dFLC, the median OS and PFS of patients in different groups were compared. The influencing factors of prognosis in newly diagnosed MM patients were analyzed by univariate and multivariate methods, the influence of different cutoff values of rFLC and dFLC on clinical prognosis were evaluated.
The median progression-free survival time of female patients with M-protein IgA type and I stage for ISS stage were significantly longer than those of male, other M-protein types and other ISS stage（P<0.05）. The median OS of patients without hypercalcemia was significantly higher than that of patients with hypercalcemia（P<0.05）. The median progression-free survival(PFS) time of patients with dFLC <110.95 mg/L was significantly longer than that of patients with dFLC=110.95-2 781.44 mg/L and >2 781.44 mg/L（P<0.05）. The median overall survival time of patients with dFLC ＜110.95 mg/L and ＞2 781.44 mg/L was significantly longer than that of patients with dFLC=110.95-2 781.44 mg/L（P<0.05）. The median overall survival time of patients with rFLC <14.71 mg/L was significantly longer than that of patients with rFLC >14.71-367.96 mg/L and >367.96 mg/L（P<0.05）. Univariate analysis of Cox regression model indicated that dFLC at all levels showed higher influence on the OS and PFS of patients as compared with rFLC（P<0.05）. Multivariate analysis of Cox regression model showed that rFLC and dFLC expression level were the independent prognostic factors of patients（P<0.05）. The most significant influence value on clinical prognosis of patients were observed when rFLC level ≤14.71 or dFLC level ≤110.95 mg/L（P<0.05）. The median OS of patients with rFLC level ≤14.71 was significantly higher than that of other groups（P<0.05）. There was significant difference in median PFS between patients with rFLC ≤14.71 and ≥367.96 mg/L（P<0.05）. The median OS and PFS of patients with dFLC ≤110.95 mg/L were significantly longer than those in other two groups（P<0.05）.
The levels of rFLC and dFLC closely relate to clinical prognosis of patients with new diagnosed MM; the risk of recurrence or death is lowest in patients with rFLC level ≤14.71 mg/L or dFLC level ≤110.95 mg/L, which can be used as the ideal cutoff value for prognosis evaluation.
探讨血清游离轻链（rFLC）和尿游离轻链（dFLC）对新诊断多发性骨髓瘤（MM）患者临床预后的影响及最佳截断值。
收集2010年1月至2016年6月在解放军西部战区总医院治疗的240例新诊断MM患者的临床资料并进行回顾性分析。根据rFLC和dFLC的四分位数间距水平将所有患者分为不同组，比较不同组患者的中位总生存期（OS）和无进展生存期（PFS）。采用单因素和多因素方法分析新诊断MM患者预后的影响因素，评估rFLC和dFLC不同截断值对临床预后的影响。
免疫球蛋白A型（M蛋白）且国际分期系统（ISS）分期为I期的女性患者的中位无进展生存时间显著长于男性、其他M蛋白类型及其他ISS分期患者（P<0.05）。血钙正常患者的中位OS显著高于高钙血症患者（P<0.05）。dFLC<110.95 mg/L患者的中位无进展生存期（PFS）显著长于dFLC为110.95 - 2781.44 mg/L和>2781.44 mg/L的患者（P<0.05）。dFLC＜110.95 mg/L和＞2781.44 mg/L患者的中位总生存时间显著长于dFLC为110.95 - 2781.44 mg/L的患者（P<0.05）。rFLC<14.71 mg/L患者的中位总生存时间显著长于rFLC为>14.71 - 367.96 mg/L和>367.96 mg/L的患者（P<0.05）。Cox回归模型单因素分析表明，与rFLC相比，各水平的dFLC对患者OS和PFS的影响更高（P<0.05）。Cox回归模型多因素分析显示，rFLC和dFLC表达水平是患者的独立预后因素（P<0.05）。当rFLC水平≤14.71或dFLC水平≤110.95 mg/L时，观察到对患者临床预后的影响最显著（P<0.05）。rFLC水平≤14.71患者的中位OS显著高于其他组（P<0.05）。rFLC≤14.71和≥367.96 mg/L患者的中位PFS有显著差异（P<0.05）。dFLC≤110.95 mg/L患者的中位OS和PFS显著长于其他两组（P<0.05）。
rFLC和dFLC水平与新诊断MM患者的临床预后密切相关；rFLC水平≤14.71 mg/L或dFLC水平≤110.95 mg/L的患者复发或死亡风险最低，可作为预后评估的理想截断值。
