Department of Hematology-Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea.
Department of Hematology-Oncology, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Hwasun-gun, Jeollanam-do, South Korea.
Blood Cancer J. 2021 Dec 1;11(12):190. doi: 10.1038/s41408-021-00577-2.
In multiple myeloma (MM), a high number of focal lesions (FL) detected using positron emission tomography/computed tomography (PET/CT) was found to be associated with adverse prognosis. To design a new risk stratification system that combines the Revised International Staging System (R-ISS) with FL, we analyzed the data of 380 patients with newly diagnosed MM (NDMM) who underwent F-fluorodeoxyglucose (F-FDG) PET/CT upon diagnosis. The K-adaptive partitioning algorithm was adopted to define subgroups with homogeneous survival. The combined R-ISS with PET/CT classified NDMM patients into four groups: R-ISS/PET stage I (n = 31; R-ISS I with FL ≤ 3), stage II (n = 156; R-ISS I with FL > 3 and R-ISS II with FL ≤ 3), stage III (n = 162; R-ISS II with FL > 3 and R-ISS III with FL ≤ 3), and stage IV (n = 31; R-ISS III with FL > 3). The 2-year overall survival rates for stages I, II, III, and IV were 96.7%, 89.8%, 74.7%, and 50.3%. The 2-year progression-free survival rates were 84.1%, 64.7%, 40.8%, and 17.1%, respectively. The new R-ISS/PET was successfully validated in an external cohort. This new system had a remarkable prognostic power for estimating the survival outcomes of patients with NDMM. This system helps discriminate patients with a good prognosis from those with a poor prognosis more precisely.
在多发性骨髓瘤（MM）中，使用正电子发射断层扫描/计算机断层扫描（PET/CT）检测到的大量局灶性病变（FL）与不良预后相关。为了设计一种新的风险分层系统，将修订后的国际分期系统（R-ISS）与 FL 相结合，我们分析了 380 例新诊断 MM（NDMM）患者的资料，这些患者在诊断时均接受了 F-氟脱氧葡萄糖（F-FDG）PET/CT 检查。采用 K 自适应分区算法定义具有同质生存的亚组。联合 R-ISS 和 PET/CT 将 NDMM 患者分为四组：R-ISS/PET Ⅰ期（n = 31；R-ISS I 且 FL ≤ 3）、Ⅱ期（n = 156；R-ISS I 且 FL > 3 且 R-ISS II 且 FL ≤ 3）、Ⅲ期（n = 162；R-ISS II 且 FL > 3 且 R-ISS III 且 FL ≤ 3）和Ⅳ期（n = 31；R-ISS III 且 FL > 3）。Ⅰ、Ⅱ、Ⅲ和Ⅳ期的 2 年总生存率分别为 96.7%、89.8%、74.7%和 50.3%。2 年无进展生存率分别为 84.1%、64.7%、40.8%和 17.1%。该新的 R-ISS/PET 在外部队列中得到了成功验证。该新系统在评估 NDMM 患者的生存结局方面具有显著的预后能力。该系统有助于更精确地区分预后良好和预后不良的患者。
