Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China.
Hubei Key Laboratory of Edible Wild Plants Conservation and Utilization, Hubei Normal University, Huangshi, Hubei, China.
Hematol Oncol. 2022 Apr;40(2):212-222. doi: 10.1002/hon.2955. Epub 2021 Dec 12.
This study aimed to evaluate the existing staging systems for multiple myeloma (MM) in the real world. From January 2010 to June 2019, we retrospectively analyzed 859 newly diagnosed MM patients from two institutions. Clinical data including laboratory findings, imaging examinations and staging system were obtained by reviewing medical records. Survival distributions were estimated using the Kaplan-Meier curve analysis, and Cox proportional hazards model were used to identified risk factors. The overall survival (OS) of eligible patients was 61.0 months. The Revised International Staging System (R-ISS) had a larger receiver operating characteristic curve area (0.603) than both the International Staging System (0.573) and the Durie Salmon staging system (0.567). In the group receiving immunomodulatory agents-based regimens, the median OS was 92.0 months in R-ISS I, 63.0 months in R-ISS II and 18.0 months in R-ISS III (p < 0.0001). In the group receiving proteasome inhibitors-based regimens, the median OS was 102.0 months in R-ISS I, 63.0 months in R-ISS II and 22.0 months in R-ISS III (p < 0.0001). In different subgroups grouped according to age, hemoglobin (HGB), creatinine, and Ca, R-ISS also had a good stratification effect. Patients in R-ISS II, which accounted for 69.9% of all patients, were further analyzed. Univariate and multivariate Cox analyses revealed that age >65 years (p = 0.001), HGB < 100 g/L (p < 0.001), elevated LDH (p = 0.001), and Ca (p = 0.010) were independent predictors of worse prognosis within R-ISS II. To conclusion, R-ISS remains a valuable staging system in the real world of the novel drug era. However, patients classified as R-ISS II still have great heterogeneity.
这项研究旨在评估多发性骨髓瘤（MM）在真实世界中的现有分期系统。我们回顾性分析了来自两个机构的 859 例新诊断的 MM 患者，这些患者的入组时间从 2010 年 1 月至 2019 年 6 月。临床数据包括实验室检查结果、影像学检查和分期系统，通过查阅病历获得。使用 Kaplan-Meier 曲线分析估计生存分布，使用 Cox 比例风险模型确定危险因素。符合条件的患者的总生存（OS）为 61.0 个月。修订后的国际分期系统（R-ISS）的接收者操作特征曲线面积（0.603）大于国际分期系统（0.573）和 Durie-Salmon 分期系统（0.567）。在接受免疫调节药物为基础的治疗方案的患者中，R-ISS I 组的中位 OS 为 92.0 个月，R-ISS II 组为 63.0 个月，R-ISS III 组为 18.0 个月（p<0.0001）。在接受蛋白酶体抑制剂为基础的治疗方案的患者中，R-ISS I 组的中位 OS 为 102.0 个月，R-ISS II 组为 63.0 个月，R-ISS III 组为 22.0 个月（p<0.0001）。根据年龄、血红蛋白（HGB）、肌酐和钙的不同亚组分组，R-ISS 也具有良好的分层效果。对占所有患者 69.9%的 R-ISS II 患者进行进一步分析。单因素和多因素 Cox 分析显示，年龄>65 岁（p=0.001）、HGB<100 g/L（p<0.001）、LDH 升高（p=0.001）和钙（p=0.010）是 R-ISS II 预后不良的独立预测因素。总之，R-ISS 在新型药物时代的真实世界中仍然是一个有价值的分期系统。然而，被归类为 R-ISS II 的患者仍然存在很大的异质性。
