The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney NSW 2006, Australia.
Cancer Biol Med. 2024 Jul 11;21(8):703-11. doi: 10.20892/j.issn.2095-3941.2024.0177.
Australia has relatively high multiple myeloma (MM) incidence and mortality rates. Advancements in MM treatment over recent decades have driven improvements in MM survival in high-income countries; however, reporting in Australia is limited. We investigated temporal trends in population-wide MM survival across 3 periods of treatment advancements in New South Wales (NSW), Australia.
Individuals with an MM diagnosis in the NSW Cancer Registry between 1985 and 2015 with vital follow-up to 2020, were categorized into 3 previously defined treatment eras according to their diagnosis date (1985-1995, chemotherapy only; 1996-2007, autologous stem cell transplantation; and 2008-2015, novel agents including proteasome inhibitors and immunomodulatory drugs). Both relative survival and cause-specific survival according to Fine and Gray's competing risks cumulative incidence function were calculated by treatment era and age at diagnosis.
Overall, 11,591 individuals were included in the study, with a median age of 70 years at diagnosis. Five-year relative survival improved over the 36-year (1985-2020) study period (31.0% in 1985-1995; 41.9% in 1996-2007; and 56.1% in 2008-2015). For individuals diagnosed before 70 years of age, the 5-year relative survival nearly doubled, from 36.5% in 1985-1995 to 68.5% in 2008-2015. Improvements for those > 70 years of age were less pronounced between 1985-1995 and 1996-2007; however, significant improvements were observed for those diagnosed in 2008-2015. Similar overall and age-specific patterns were observed for cause-specific survival. After adjustment for gender and age at diagnosis, treatment era was strongly associated with both relative and cause-specific survival ( < 0.0001).
Survival of individuals with MM is improving in Australia with treatment advances. However, older age groups continue to experience poor survival outcomes with only modest improvements over time. Given the increasing prevalence of MM in Australia, the effects of MM treatment on quality of life, particularly in older age, warrant further attention.
澳大利亚多发性骨髓瘤（MM）的发病率和死亡率相对较高。近几十年来，MM 治疗的进步推动了高收入国家 MM 生存率的提高；然而，澳大利亚的报告有限。我们调查了新南威尔士州（NSW）三个治疗进展时期的 MM 全人群生存的时间趋势。
1985 年至 2015 年间在新南威尔士州癌症登记处诊断为 MM 且有生存随访至 2020 年的患者，根据诊断日期分为三个预先定义的治疗时期（1985-1995 年，仅化疗；1996-2007 年，自体干细胞移植；2008-2015 年，新型药物包括蛋白酶体抑制剂和免疫调节药物）。根据 Fine 和 Gray 的竞争风险累积发生率函数，按治疗时期和诊断时的年龄计算相对生存率和特定原因生存率。
总体而言，共有 11591 人纳入研究，诊断时的中位年龄为 70 岁。在 36 年（1985-2020 年）的研究期间，5 年相对生存率有所提高（1985-1995 年为 31.0%；1996-2007 年为 41.9%；2008-2015 年为 56.1%）。对于诊断时年龄小于 70 岁的患者，5 年相对生存率几乎翻了一番，从 1985-1995 年的 36.5%提高到 2008-2015 年的 68.5%。1985-1995 年至 1996-2007 年期间，70 岁以上患者的改善不明显；然而，2008-2015 年诊断的患者则有显著改善。特定原因生存率也观察到类似的整体和年龄特异性模式。在调整性别和诊断时的年龄后，治疗时期与相对和特定原因生存率密切相关（<0.0001）。
随着治疗的进步，澳大利亚 MM 患者的生存正在改善。然而，老年人群的生存结果仍然较差，随着时间的推移只有适度的改善。鉴于 MM 在澳大利亚的患病率不断增加，MM 治疗对生活质量的影响，特别是在老年人群中的影响，值得进一步关注。
