四种衰弱模型对老年多发性骨髓瘤患者的评估及对患者生存的预测效能  

Evaluation of four frailty models in elderly patients with multiple myeloma and their predictive efficacy in patient survival

作　　者：李玉军 徐建梅 张江勃 赵松颖[1] 王静[1] 郭慧梅[1] 范丽霞[1] 刘丽洋 化罗明[1] 薛华[1] LI Yujun;XU Jianmei;ZHANG Jiangbo;ZHAO Songying;WANG Jing;GUO Huimei;FAN Lixia;LIU Liyang;HUA Luoming;XUE Hua(Department of Hematology,Affiliated Hospital of Hebei University,Hebei Baoding 071000,China.)

机构地区：[1]河北大学附属医院血液科,河北保定071000

出　　处：《现代肿瘤医学》2023年第5期921-926,共6页Journal of Modern Oncology

摘　　要：目的:探索国际骨髓瘤工作组(International Myeloma Working Group, IMWG)衰弱评分、梅奥(Mayo)评分、英国骨髓瘤研究联盟风险(Myeloma Research Alliance Risk Profile, MRP)评分及IFM简易评分对老年多发性骨髓瘤(multiple myeloma,MM)患者衰弱评估结果的一致性及其分层对患者生存的预测效能。方法:通过IMWG衰弱评分、Mayo评分、MRP评分及IFM简易评分对我院新诊断的73例≥60岁MM患者进行评估,分别使用Cohen’s kappa及Kaplan-Meier法进行一致性分析及生存分析。结果:共55例(75.3%)患者至少通过一种模型识别为衰弱,其中仅有12例(30.8%)被四种模型共同识别,虽然IMWG衰弱评分与MRP评分及IFM简易评分的评估结果均达到了中等的一致性(Cohen’s kappa 0.447~0.563,P<0.001),但四种衰弱模型间的一致性较低(Cohen’s kappa 0.226~0.563)。IMWG衰弱评分、Mayo评分、MRP评分识别的衰弱组和非衰弱组患者的中位总生存期(overall survival,OS)(P分别为0.01、0.003、<0.001)及无进展生存期(progression-free survival,PFS)(P分别为0.02、0.024、0.001)差异具有统计学意义,而通过四种模型所识别的衰弱患者的中位OS(P=0.275)及PFS(P=0.287)均无统计学差异。结论:本研究中四种衰弱模型识别结果的一致性较低,而MRP评分与IMWG衰弱评分的一致性更高,对患者预后的分层效能优于Mayo评分及IFM简易评分,更符合国内老年MM患者简便、客观、高效的需求。Objective:To explore the agreement and prognostic value of stratification on survival of the International Myeloma working Group(IMWG) frailty score, Mayo score, British Myeloma Research Alliance Risk Profile(MRP) and IFM simplified frailty scale in the assessment of elderly multiple myeloma(MM).Methods:73 newly diagnosed MM patients aged 60 and over in our hospital were evaluated by IMWG frailty score, Mayo score, MRP score and IFM simplified frailty scale.Cohen’s kappa and Kaplan-Meier methods were used for agreement analysis and survival analysis.Results:A total of 55 patients(75.3%) were identified as frail by at least one model, of which only 12 cases(30.8%) were identified by the four models.Although the IMWG frailty score was moderately consistent with MRP score and IFM simple score(Cohen’s kappa 0.447~0.563,P<0.001),the agreement among the four models was lower(Cohen’s kappa 0.226~0.563).The median overall survival time(OS,P=0.01,0.003,<0.001) and progression-free survival time(PFS,P=0.02,0.024,0.001) identified by IMWG frailty score, Mayo score and MRP score were statistically significant, while there was no significant difference in median OS(P=0.275) and PFS(P=0.287) of frailty patients identified by the four models.Conclusion:The agreement of the evaluation results of the four models in this study is lower.While the agreement of MRP score and IMWG frailty score is higher.The stratification efficiency of prognosis is better than the other models, which is more in line with the simple, objective and efficient needs of domestic elderly MM patients.

关 键 词：多发性骨髓瘤 衰弱 老年评估 预后 

分 类 号：R733.3[医药卫生—肿瘤]