论文部分内容阅读
目的:探讨修订的国际分期系统(R-ISS)对初诊多发性骨髓瘤(MM)的预后价值.方法:对189例初诊的MM患者进行FISH或cIg-FISH检测细胞遗传学异常,并统计疾病分期及生存情况.结果:t(4;14)阳性者24例(13.5％,24/178),del(17p)阳性者20例(10.7％,20/187).对比阴性患者,t(4;14)及 del(17p)阳性患者具有较短的中位无进展生存(PFS),差异有统计学意义(P＜0.05),而中位总生存(OS)差异无统计学意义,但t(4;14)阳性患者与阴性患者生存曲线有分离趋势.t(14;16)阳性患者仅5例,未单独分析.多因素分析显示,年龄、乳酸脱氢酶(LDH)和del(17p)是评估OS的独立预后因素(P＜0.05) ; LDH、del(17p)和t(4;14)是评估PFS的独立预后因素(P＜0.05).R-ISS分期I、Ⅱ和Ⅲ期患者分别为16、142和31例,1年OS率分别为100％、89％ 和65％(P＜0.001),1年 PFS率分别为86％、77％和52％(P = 0.002) ;ISS分期 I、Ⅱ、Ⅲ期患者分别为23、77和89例,1年 OS率分别为90％、88％和83％= 239),1年 PFS率分别为72％、73％和74％(P=0.672).结论:t(4;14)、del(17p)核型异常及LDH均是预后不良因素;基于LDH和细胞遗传学异常基础上的R-ISS分期在初诊MM患者的预后评估中优于ISS分期系统.“,”Objective: To investigate the prognostic value of revised international staging system (R-ISS) in newly diagnosed multiple myeloma (MM) patients. Method: A total of 189 patients with newly diagnosed MM were enrolled. The cytogenetic abnormalities were detected by iFISH or clg-FISH. R-ISS and ISS staging were performed on all the patients and the clinical outcome was analyzed. Result: t(4; 14) positive patients were 24 cases (13.5％),del(17p) positive patients were 20 cases (10.7％). Patients with t(4;14) or del(17p) positive had a significant shorter PFS than those negative (P＜0.05). Although there was no significant difference in OS between patients with or without these two cytogenetic abnormalities, patients with t(4 ; 14) positive had longer survival time. Only 5 patients were t(14;16) positive,a separate analysis was not performed. Multivariate analysis by COX regression showed that age,LDH and del(17p) were independent prognostic factors for OS (P＜0.05). LDH,del (17p) and t(4;14) were independent prognostic factors for PFS (P＜0.05). Patients with I,Ⅱ,Ⅲ stage in R-ISS staging were 16,142 and 31 cases,and 1-year OS were 100％,89％ and 65％ (P＜0.001),l-year PFS were 86％, 77％ and 52％ (P = 0.002). Patients with I,Ⅱ,Ⅲ stage in ISS staging were 23,77 and 89 cases,and 1-year OS were 90％,88％ and 83％ (P = 0.239), 1-year PFS were 72 ％, 73 ％ and 74％ (P=0.672). Conclusion: Cytogenetic abnormalities and LDH are predictive factors for poor prognosis;R-ISS staging based on LDH and cytogenetic abnormalities is superior to the ISS staging system in the prognostic evaluation of newly diagnosed MM patients.