Cancer Registry of North Rhine-Westphalia, Bochum, Germany.
Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany.
BMC Cancer. 2023 Apr 6;23(1):317. doi: 10.1186/s12885-023-10787-5.
Steady evolution of therapies has improved prognosis of patients with multiple myeloma (MM) over the past two decades. Yet, knowledge about survival trends and causes of death in MM might play a crucial role in long-term management of this patient collective. Here, we investigate time trends in myeloma-specific survival at the population level over two decades and analyse causes of death in times of prolonged survival.
Age-standardised and age group-specific relative survival (RS) of MM patients aged < 80 years at diagnosis was estimated for consecutive time periods from 2000-2019 using data from the Cancer Registry of North Rhine-Westphalia in Germany. Conditional RS was estimated for patients who already survived one to five years post diagnosis. Causes of death in MM patients were analysed and compared to the general population using standardised mortality ratios (SMR).
Three thousand three hundred thirty-six MM cases were included in the time trend analysis. Over two decades, age-standardised 5-year RS increased from 37 to 62%. Age-specific survival improved from 41% in period 2000-2004 to 69% in period 2015-2019 in the age group 15-69 years, and from 23 to 47% in the age group 70-79 years. Conditional 5-year RS of patients who survived five years after diagnosis slightly improved as compared to unconditional 5-year RS at diagnosis. MM patients are two times more likely to die from non-myeloma malignancies (SMR = 1.97, 95% CI 1.81-2.15) and from cardiovascular diseases (SMR = 2.01, 95% CI 1.86-2.18) than the general population.
Prognosis of patients with MM has markedly improved since the year 2000 due to therapeutic advances. Nevertheless, late mortality remains a major concern. As survival improves, second primary malignancies and cardiovascular events deserve increased attention.
在过去的二十年中，治疗方法的不断发展改善了多发性骨髓瘤（MM）患者的预后。然而，了解 MM 患者的生存趋势和死亡原因可能对该患者群体的长期管理起着至关重要的作用。在这里，我们研究了在过去二十年中人群水平上骨髓瘤特异性生存的时间趋势，并分析了在生存时间延长的情况下的死亡原因。
使用德国北莱茵-威斯特法伦癌症登记处的数据，对诊断时年龄<80 岁的 MM 患者连续时间段的年龄标准化和年龄组特异性相对生存率（RS）进行估计。对已经在诊断后存活 1 至 5 年的患者，估计了条件 RS。对 MM 患者的死因进行了分析，并与一般人群进行了比较，使用了标准化死亡率比（SMR）。
3336 例 MM 病例被纳入时间趋势分析。在过去的二十年中，年龄标准化的 5 年 RS 从 37%增加到了 62%。年龄特异性生存率在年龄组 15-69 岁的患者中从 2000-2004 年的 41%提高到了 2015-2019 年的 69%，而在年龄组 70-79 岁的患者中从 23%提高到了 47%。与诊断时的无条件 5 年 RS 相比，诊断后存活 5 年的患者的 5 年条件 RS 略有改善。MM 患者死于非骨髓瘤恶性肿瘤的可能性是一般人群的两倍（SMR=1.97，95%CI 1.81-2.15），死于心血管疾病的可能性是一般人群的两倍（SMR=2.01，95%CI 1.86-2.18）。
由于治疗的进步，自 2000 年以来，MM 患者的预后有了显著改善。然而，晚期死亡率仍然是一个主要关注点。随着生存的改善，第二原发恶性肿瘤和心血管事件需要引起更多的关注。
