Li Guang, Song Yan-Ping, Lv Yao, Li Zhen-Zhen, Zheng Yan-Hua
Institute of Hematology, Xi'an Central Hospital, Xi'an, Shaanxi, China.
Department of Hematology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
J Oncol. 2021 Jan 30;2021:6681521. doi: 10.1155/2021/6681521. eCollection 2021.
Extramedullary disease (EMD), an infrequent manifestation of multiple myeloma (MM), can present at diagnosis or develop during the disease course. EMD can be clinically divided into bone-related EMD (EMD-B) and soft tissue-related EMD (EMD-S). The purpose of our study is to investigate the clinical characteristics, survival outcomes, and prognostic factors of MM patients with EMD.
A total of 155 MM patients with EMD were ultimately enrolled in our study by retrieving the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan-Meier survival curves and log-rank test for overall survival (OS) and myeloma-specific survival (MSS) were conducted to compare each potential variable. Variables with a value <0.1 in the univariate Cox regression were incorporated into the multivariate Cox model to determine the independent prognostic factors, with a hazard ratio (HR) >1 representing adverse prognostic factors.
The median age at diagnosis was 63 years old. EMD-B occurred in 99 patients (63.90%), while EMD-S occurred in 56 cases (36.10%). Patients with EMD-S had a significant survival disadvantage in MSS (HR = 1.844, 95% CI 1.117-3.042, = 0.017) and OS (HR = 1.853, 95% CI 1.166-2.942, = 0.009) compared to those with EMD-B. Patients with EMD interval ≤24 months were at higher risk of death than those with EMD at diagnosis in MSS (HR = 1.885, 95% CI 1.175-3.346, = 0.042) and in OS (HR = 1.33, 95% CI 1.119-2.529, = 0.036). Patients with EMD interval >24 months were at a lower risk of death as opposed to those with EMD at diagnosis.
Age at MM diagnosis, site of EMD, and time interval from diagnosis to EMD occurrence were independent prognostic factors in MM patients with EMD. EMD-B bore a better prognosis than EMD-S.
髓外疾病（EMD）是多发性骨髓瘤（MM）的一种罕见表现，可在诊断时出现或在疾病过程中发生。EMD在临床上可分为骨相关EMD（EMD-B）和软组织相关EMD（EMD-S）。我们研究的目的是调查伴有EMD的MM患者的临床特征、生存结局和预后因素。
通过检索监测、流行病学和最终结果（SEER）数据库，最终共有155例伴有EMD的MM患者纳入我们的研究。采用Kaplan-Meier生存曲线和对数秩检验对总生存期（OS）和骨髓瘤特异性生存期（MSS）进行分析，以比较各潜在变量。单因素Cox回归中P值<0.1的变量纳入多因素Cox模型以确定独立预后因素，风险比（HR）>1表示不良预后因素。
诊断时的中位年龄为63岁。EMD-B发生在99例患者中（63.90%），而EMD-S发生在56例患者中（36.10%）。与EMD-B患者相比，EMD-S患者在MSS（HR = 1.844，95%CI 1.117 - 3.042，P = 0.017）和OS（HR = 1.853，95%CI 1.166 - 2.942，P = 0.009）方面存在显著的生存劣势。EMD间隔≤24个月的患者在MSS（HR = 1.885，95%CI 1.175 - 3.346，P = 0.042）和OS（HR = 1.33，95%CI 1.119 - 2.529，P = 0.036）方面比诊断时即伴有EMD的患者死亡风险更高。与诊断时即伴有EMD的患者相比，EMD间隔>24个月的患者死亡风险较低。
MM诊断时的年龄、EMD部位以及从诊断到EMD发生的时间间隔是伴有EMD的MM患者的独立预后因素。EMD-B的预后优于EMD-S。
