Hou Zi-Liang, Kang Yu, Yang Guang-Zhong, Wang Zhen, Wang Feng, Yu Yan-Xia, Chen Wen-Ming, Shi Huan-Zhong
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, 101100, China.
Ann Hematol. 2021 Jul;100(7):1789-1801. doi: 10.1007/s00277-021-04484-1. Epub 2021 Mar 14.
Pleural effusion (PE) is prevalent in unselected "real-life" populations of multiple myeloma (MM). However, its prognostic value on MM is currently elusive. This study aimed to explore the role of PE on MM prognosis and to develop a novel prognostic nomogram for a cohort of Chinese patients with MM. Patients diagnosed with MM form 2000 through 2017 were retrospectively enrolled. PE was evaluated by chest computed tomography (CT) scans. Independent predictors of overall survival (OS) were identified using a multivariable Cox regression model performed on variables selected by the least absolute shrinkage and selection operator (LASSO) algorithm. A nomogram was constructed based on these variables. The concordance index (C-index) and the calibration curve were used to evaluate the predictive performance of the nomogram. Among 861 patients analyzed, 368 patients developed PE. Multivariate cox regression and restricted mean survival time (RMST) analyses revealed that patients with PE experienced worse OS vs. patients without PE. A nomogram predictive of OS was constructed using PE, plasma cell proportion, international staging system (ISS) stage, Charlson comorbidity index (CCI), 1q21 gain, and autologous hematopoietic stem cell transplantation (HSCT). The nomogram showed satisfactory discrimination in the derivation cohort (C-index=0.729) and the validation cohort (C-index=0.684), outperforming the Durie-Salmon (DS) and ISS staging systems. Moreover, the nomogram accurately classified patients into two distinct high- and low-risk groups. PE is frequently encountered in the disease course for MM patients. We derivated and validated a novel nomogram for MM based on PE, outperforming the DS/ISS staging systems.
胸腔积液（PE）在未经过挑选的多发性骨髓瘤（MM）“真实世界”人群中很常见。然而，其对MM的预后价值目前尚不清楚。本研究旨在探讨PE在MM预后中的作用，并为一组中国MM患者开发一种新的预后列线图。回顾性纳入了2000年至2017年诊断为MM的患者。通过胸部计算机断层扫描（CT）评估PE。使用基于最小绝对收缩和选择算子（LASSO）算法选择的变量进行多变量Cox回归模型来确定总生存期（OS）的独立预测因素。基于这些变量构建列线图。一致性指数（C指数）和校准曲线用于评估列线图的预测性能。在分析的861例患者中，368例患者发生了PE。多变量Cox回归和受限平均生存时间（RMST）分析显示，与无PE的患者相比，有PE的患者OS更差。使用PE、浆细胞比例、国际分期系统（ISS）分期、Charlson合并症指数（CCI）、1q21增益和自体造血干细胞移植（HSCT）构建了预测OS的列线图。该列线图在推导队列（C指数=0.729）和验证队列（C指数=0.684）中显示出令人满意的区分度，优于Durie-Salmon（DS）和ISS分期系统。此外，列线图准确地将患者分为两个不同的高风险和低风险组。MM患者在病程中经常出现PE。我们基于PE推导并验证了一种新的MM列线图，其性能优于DS/ISS分期系统。
