Division of Hematology, Città della Salute e della Scienza Hospital, Torino, Italy.
Hematology Division, San Gerardo Hospital, ASST Monza, Monza, Italy.
Hematol Oncol. 2021 Aug;39(3):409-418. doi: 10.1002/hon.2843. Epub 2021 Mar 8.
In 816 patients with 2016 World Health Organization-defined polycythemia vera (PV) enrolled in a multicenter retrospective study, we investigated the predictive value of Charlson comorbidity index (CCI) and body mass index (BMI) on thrombosis, progression to post-PV myelofibrosis (PPV-MF) and survival. Patients were subgrouped according to CCI = 0 (58.1%, no comorbidities) or CCI ≥ 1 (41.9%) and according to normal/underweight (BMI < 25, 54.5%) or overweight/obesity (BMI ≥ 25, 45.5%) at PV diagnosis. BMI was available for 529 patients. Patients with CCI ≥ 1 were older and more frequently presented cardiovascular risk factors compared to patients with CCI = 0 (p < 0.001), while overweight/obese patients were more frequently males (p < 0.001). Cumulative incidence of thromboses with death as competing risk was 13.3% at 10 years. Multivariable analysis with death as competing risk showed that previous thromboses (subdistribution hazard ratio [SHR]: 2.1, p = 0.01) and hypertension (SHR: 1.77, p = 0.04) were significantly associated with a higher thrombotic risk, while BMI ≥ 25 lost statistical significance (SHR: 1.69, p = 0.05) and CCI ≥ 1 was excluded after evaluation of goodness of fit. After a median follow-up of 6.1 years, progression to PPV-MF occurred in 44 patients, and 75 patients died. BMI ≥ 25 was associated with a lower probability of progression to PPV-MF (SHR: 0.38, CI95%: 0.15-0.94, p = 0.04) and better survival (hazard ratio [HR]: 0.42, CI95%: 0.18-0.97, p = 0.04). CCI ≥ 1 did not affect progression to PPV-MF (p = 0.44) or survival (p = 0.71). The evaluation of CCI and BMI may improve the prognostic definition of PV. In patients with hypertension an accurate evaluation of thrombotic risk is warranted.
在一项多中心回顾性研究中，我们纳入了 816 名符合 2016 年世界卫生组织定义的真性红细胞增多症 (PV) 患者，研究Charlson 合并症指数 (CCI) 和体重指数 (BMI) 对血栓形成、进展为 PV 后骨髓纤维化 (PPV-MF) 和生存的预测价值。根据 CCI = 0（58.1%，无合并症）或 CCI ≥ 1（41.9%）将患者分组，并根据 PV 诊断时的 BMI 是否正常/体重不足 (BMI < 25，54.5%) 或超重/肥胖 (BMI ≥ 25，45.5%) 进行分组。有 529 名患者的 BMI 可用。与 CCI = 0 的患者相比，CCI ≥ 1 的患者年龄更大，且更常出现心血管危险因素 (p < 0.001)，而超重/肥胖患者中男性更为常见 (p < 0.001)。10 年时伴有死亡竞争风险的血栓累积发生率为 13.3%。考虑死亡竞争风险的多变量分析显示，既往血栓形成 (亚分布危险比 [SHR]：2.1，p = 0.01) 和高血压 (SHR：1.77，p = 0.04) 与更高的血栓形成风险显著相关，而 BMI ≥ 25 则失去统计学意义 (SHR：1.69，p = 0.05)，且在评估拟合优度后排除了 CCI ≥ 1。中位随访 6.1 年后，44 例患者进展为 PPV-MF，75 例患者死亡。BMI ≥ 25 与较低的进展为 PPV-MF 概率相关 (SHR：0.38，95%CI：0.15-0.94，p = 0.04) 和更好的生存相关 (HR：0.42，95%CI：0.18-0.97，p = 0.04)。CCI ≥ 1 并不影响进展为 PPV-MF (p = 0.44) 或生存 (p = 0.71)。CCI 和 BMI 的评估可能改善 PV 的预后定义。对于高血压患者，需要准确评估血栓形成风险。
