Wutke K, Rüdiger K D, Kelényi G
Arch Geschwulstforsch. 1979;49(8):671-84.
Clinical staging has been widely accepted as essential for optimal treatment of many types of cancer. Various groups of workers have investigated factors which influence prognosis in multiple myeloma. Important factors which have been indentified include the performance status, the presence or absence of renal insufficiency, the quantity of the monoclonal protein fraction in the serum, the extent of bone lesions, the serum concentration of albumin and calcium, and the hemoglobin level. Since our findings agreed with the staging, previously proposed by Salmon, this procedure was used to stage myeloma cases in a retrospective study. Survival was statistically significant shorter in stage III than in stage I and in subtype B shorter than in subtype A. In addition to the clinical findings we propose a system for the cytological and histological staging of multiple myeloma which is based on differences in maturity of myeloma cells and have tested its validity in predicting survival in a retrospective follow-up study. 202 cases of multiple myeloma have been analysed by cytological and histological methods. On the basis of the findings the following types were distinguished: 1. plasmocytic myeloma (127 cases), 2. plasmoblastic-plasmocytic myeloma (35 cases), and 3. plasmoblastic myeloma (32 cases). In 8 cases predominance of giant cells were seen. In types 2 and 3 involvement of extraskeletal sites (lymph node, liver, spleen) was significantly higher than in type 1, just as survival was significantly higher (39,7 months) in this type than in type 3 (9,8 months). There seemed to be no correlation between morphological type and class specificity of monoclonal immunoglobulins. Use of the clinical and morphological staging system should provide better initial assessment and follow-up of individual patients, and should lead to improved study design and analysis in large clinical trials of diagnosis and therapy for multiple myeloma.
临床分期已被广泛认为是多种癌症最佳治疗的关键。不同的研究团队已对影响多发性骨髓瘤预后的因素进行了调查。已确定的重要因素包括身体状况、肾功能不全的有无、血清中单克隆蛋白组分的量、骨病变的程度、血清白蛋白和钙的浓度以及血红蛋白水平。由于我们的研究结果与Salmon先前提出的分期一致，因此在一项回顾性研究中采用该方法对骨髓瘤病例进行分期。Ⅲ期患者的生存期在统计学上显著短于Ⅰ期患者，B亚型患者的生存期显著短于A亚型患者。除了临床发现外，我们还提出了一种基于骨髓瘤细胞成熟度差异的多发性骨髓瘤细胞学和组织学分期系统，并在一项回顾性随访研究中检验了其预测生存期的有效性。我们采用细胞学和组织学方法分析了202例多发性骨髓瘤病例。根据研究结果区分出以下类型：1. 浆细胞性骨髓瘤（127例），2. 成浆细胞 - 浆细胞性骨髓瘤（35例），3. 成浆细胞性骨髓瘤（32例）。8例可见巨细胞占优势。在第2型和第3型中，骨骼外部位（淋巴结、肝脏、脾脏）受累明显高于第1型，同样，该型患者的生存期（39.7个月）也明显高于第3型患者（9.8个月）。形态学类型与单克隆免疫球蛋白的类别特异性之间似乎没有相关性。使用临床和形态学分期系统应能为个体患者提供更好的初始评估和随访，并应能改进多发性骨髓瘤诊断和治疗大型临床试验的研究设计和分析。
