外周血血小板与淋巴细胞比值对初诊时伴髓外病变多发性骨髓瘤患者预后的影响  

Effects of pre-treatment peripheral blood platelet-to-lymphocyte ratio on prognosis of newly-diagnosed multiple myeloma patients with extramedullary involvements

作　　者：张小影[1] 陈亚芳[1] 赵盼[1] 杨洪亮[1] 赵海丰[1] 于泳[1] 王亚非[1] 赵智刚[1] 张翼鷟[1] 王晓芳[1] 

机构地区：[1]天津医科大学肿瘤医院,国家肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津300060

出　　处：《肿瘤》2016年第5期574-580,共7页Tumor

基　　金：国家自然科学基金资助项目(编号:81272562)~~

摘　　要：目的 ：探讨治疗前外周血血小板/淋巴细胞比值（platelet-to-lymphocyte ratio,PLR）与初诊时伴髓外病变（extramedullary disease,EMD）的多发性骨髓瘤患者临床病理特征的相关性,以及对预后的影响。方法 ：回顾分析61例初诊时伴EMD的多发性骨髓瘤患者的临床病理特征、治疗效果、生存情况及预后。按中位PLR将患者分为低PLR组和高PLR组,观察PLR与患者临床病理特征及预后之间的关系。结果 ：全组患者的PLR为45-273,中位值为128。低PLR组（≤128）30例,高PLR组（〉128）31例。EMD最常见的受累部位依次为软组织、中枢神经系统、肺部、胸腹膜、皮肤和椎管;其他较少见的部位包括眼附属器、纵隔、乳腺、骨骼肌和卵巢。PLR与临床分期、β2微球蛋白、溶骨性病变数目和骨髓浆细胞比例相关（P值均〈0.05）。全组患者的1、3和5年生存率分别为88.2%、62.2%和23.9%;治疗前低PLR组患者的1、3和5年生存率分别为96.4%、77.4%和57.4%,高PLR组患者的1、3和5年生存率分别为80.6%、49.9%和10.0%,差异有统计学意义（P=0.005）。单因素分析结果显示,β2微球蛋白（P=0.019）、溶骨性病变数目（P=0.049）以及接受治疗前外周血PLR（P=0.005）是影响患者预后的不良因素。COX多因素风险回归分析结果显示,仅PLR〉128是独立的预后不良因素（P=0.029）。结论 ：PLR作为一种简单、经济、可重复检测的全身炎性反应指标,对初诊时伴EMD的多发性骨髓瘤患者的预后评估具有一定的临床应用价值,治疗前高PLR提示此类疾病的预后可能不良。Objective： To investigate the correlation between pre-treatment peripheral blood platelet-to-lymphocyte ratio （PLR） and clinicopathological features, as well as the effect of PLR on the prognosis of newly-diagnosed multiple myeloma patients with extramedullary disease （EMD）. Methods： Retrospective analysis was performed for 61 cases histologically confirmed of newly-diagnosed multiple myeloma with extramedullary involvements. All patients were classified into two groups based on the median value of PLR. The relationship between PLR and clinicopathological features was studied. Univariate and multivariate analyses were performed to assess the prognostic effect of preoperative PLR. Results： The median value of pre-treatment PLR was 128 （range： 45 to 273）. Based on the cut-off value of 128, all patients were divided into two groups： low PLR （≤128, n = 30） and high PLR （〉 128, n = 31）. The common locations of EMD were soft tissues, central nervous system, lung, pleuroperitoneum, skin and spinal canal. Other less common parts included ocular adnexal, mediastinum, breast, skeletal muscle and ovary. PLR was associated with higher clinical stage, β2-microglobulin level, the number of osteolytic lesions and the proportion of plasma cells in bone marrow （all P 〈 0.05）. The expected 1-year, 3-year and 5-year overall survival rates （OS） were 88.2%, 62.2% and 23.9%, respectively; which in the low and high PLR groups were 96.4%, 77.4% and 57.4% vs 80.6%, 49.9% and 10.0%, respectively （P = 0.005）. Univariate analysis showed that β2-microglobulin level, the number of osteolytic lesions and PLR value were associated with the survival. Multivariate analysis identified only PLR 〉 128 was the independent poor prognostic factor. Conclusion： Pretreatment PLR is an easily measured, reproducible and inexpensive marker of systemic inflammation and thus shows a prognostic and predictive value in prognosis evaluation for patients newly-diagnosed of multiple myeloma with extramedullary i

关 键 词：多发性骨髓瘤 髓外病变 血小板与淋巴细胞比值 预后 

分 类 号：R733.3[医药卫生—肿瘤]