112例多发性骨髓瘤患者ISS分期分析及与DS分期、IFM分期的比较  

Analysis of the International Staging System of multiple myeloma and its comparison with the DS and IFM staging system in 122 Chinese patients

作　　者：邓书会 徐燕 麦玉洁 王亚非 赵耀中 邹德慧 邱录贵 

机构地区：[1]中国医学科学院血液学研究所、血液病医院实验血液学国家重点实验室,天津300020

出　　处：《中华血液学杂志》2008年第4期217-221,共5页Chinese Journal of Hematology

基　　金：天津市科技发展计划项目（06YFSYSF01900）

摘　　要：目的探讨国际分期体系（ISS）在我国多发性骨髓瘤（MM）患者中的适用性，并与Durie-Salmon（DS）分期、法国骨髓瘤工作组（IFM）分期进行比较。方法对112例具有ISS分期资料的MM初诊患者进行回顾性分析。结果①预后因素：血清β2微球蛋白（β2-MG）≥3．5mg／L是患者总体生存（OS）时间的独立预后不良因素，血清白蛋白（ALB）〈35g／L是患者疾病进展时间（TTP）的独立预后不良因素；在有核型检测结果的58例患者中，13号染色体异常（△13）是OS时间的唯一独立预后不良因素；②临床指标相关性：与血清-MG显著相关的因素有血清肌酐、24h尿蛋白定量、体重指数（BMI）、体能分级（Ps）；与血清ALB显著相关的因素有血红蛋白浓度、骨髓浆细胞比例、乳酸脱氢酶（LDH）、发热、Ps、M蛋白类型、血清磷、BMI；③ISS分期临床特征：除血清β2-MG和肌酐外，其他传统预后指标在Ⅱ、Ⅲ期间的差异无统计学意义；6例△13阳性患者中5例划入ISS Ⅱ期；④预后效能比较：ISS分期中Ⅰ、Ⅱ、Ⅲ期患者的中位OS时间分别为69、23和26个月，其中Ⅱ、Ⅲ期间差异无统计学意义；DS分期中89．5％的患者被归入Ⅲ期，Ⅰ、Ⅱ期与Ⅲ期间预后差异无统计学意义；IFM分期中低、中、高危三组患者的中位OS时间依次为69、40和8个月，其中低、中危组与高危组间差异有统计学意义。结论ISS分期体系Ⅱ、Ⅲ期的划分似乎并不适用于中国MM患者；ISS、DS、IFM三个分期体系比较后发现纳入遗传学指标△13的IFM体系区分预后效能最佳。Objective To verify applicability of the International Staging System （ISS）for multiple myeloma（ MM ） to 112 Chinese MM patients and compare ISS with Durie-Salmon（DS） and Intergroup Francophone du Myelome（IFM） staging system in predicting prognosis. Methods 112 previously untreated MM patients in Blood Diseases Hospital of CAMS were analyzed according to ISS retrospectively. Results ①Serum β2-microglobulin （β-MG） ≥ 3.5 mg/L was an independent adverse prognostic factor for overall survival （OS） , and serum albumin 〈 35 g/L predicted for time to progression（TIP） , ②In the 58 cases having cytogenetic data, chromosome 13 aberration （△13 ） was the only independent adverse prognostic factor for OS; ③ Factors significantly related to serum β2-MG were serum creatinine,24h urinary protein,body mass index （BMI） and performance status（PS） ; and those related to serum albumin were hemoglobin level,percentage of bone marrow plasma cells ,lactate dehydrogenase（ LDN ） , fever, PS, class of M-protein, serum phosphorus and BMI;④All traditional prognostic factors had no statistical difference between ISS stage Ⅱ and Ⅲ excepting for serum β2-MG and creatinine, and 5/6 △13 patients were classified to ISS stage Ⅱ ;⑤The median OS of ISS stage Ⅰ , Ⅱ , Ⅲ were 69、23 and 26 months（m） respectively, being no statistical difference between stage Ⅱ and Ⅲ ; for DS system, 89.5% of patients were classified in stage Ⅲ, being no statistical difference for OS between the stage Ⅰ / Ⅱ and Ⅲ ; while for IFM system, the median OS of low-,intermediate- and high-risk group were 69、40 and 8 months respectively, being statistically different between high-risk and intermediate/ low-risk groups. Conclusions From the result of our limited analysis, the staging of ISS Ⅱ and Ⅲ seems unsuitable for Chinese MM patients. The IFM staging system ,which incorporates △13, is more effective than ISS ,and DS staging system in predicting prognosis.

关 键 词：多发性骨髓瘤 肿瘤分期 预后 染色体畸变 

分 类 号：R686[医药卫生—骨科学]