多发性骨髓瘤患者继发或伴发第二肿瘤的临床特征及预后转归分析  

Clinical Features and Prognosis of Multiple Myeloma Patients with Secondary Primary Malignancies

作　　者：李玲玲 李梦琳 张雨 刘宇[1] 刘延方[1] 姜中兴[1] 陈绍倩[1] 王树娟[1] 王冲[1] LI Ling-Ling;LI Meng-Lin;ZHANG Yu;LIU Yu;LIU Yan-Fang;JIANG Zhong-Xing;CHEN Shao-Qian;WANG Shu-Juan;WANG Chong(Department of Hematology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China)

机构地区：[1]郑州大学第一附属医院血液科,河南郑州450052

出　　处：《中国实验血液学杂志》2023年第2期429-434,共6页Journal of Experimental Hematology

基　　金：国家自然科学基金项目(81800137,U1804191)。

摘　　要：目的:探讨多发性骨髓瘤(MM)患者继发或伴发第二肿瘤的临床特点及预后转归。方法:回顾性分析2011年1月到2019年12月就诊于郑州大学第一附属医院的初诊MM患者的临床资料,从中检索出继发或伴发第二肿瘤的患者,评估其临床特征及预后转归。结果:共纳入1935例初诊MM患者,中位年龄为62(18-94)岁,其中≥2次住院者共计1049人。继发或伴发第二肿瘤者11例,发病率为1.05%,其中血液系统肿瘤3例(急性粒单核细胞白血病2例,急性早幼粒细胞白血病1例),实体肿瘤8例(肺腺癌2例,子宫内膜癌、食管鳞癌、原发性肝癌、膀胱癌、宫颈鳞癌、脑膜瘤各1例),中位发病年龄57岁,恶性肿瘤诊断与MM诊断间隔中位时间为39.4个月。原发或继发浆细胞白血病7例,发病率0.67%,中位发病年龄为52岁。与随机对照组相比,继发或伴发第二肿瘤组β2-微球蛋白水平较低(P=0.028)、ISS分期处于I/II期者较多(P=0.029)。11例继发或伴发第二肿瘤患者中存活1例,死亡10例,中位生存期40个月。MM患者继发第二肿瘤后的中位生存时间仅为7个月。7例原发或继发浆细胞白血病患者均死亡,中位生存期为14个月。MM继发或伴发第二肿瘤患者较浆细胞白血病患者的中位总生存期长(P=0.027)。结论:MM患者继发或伴发第二肿瘤发生率为1.05%,继发第二肿瘤后患者预后差,生存期短,但较浆细胞白血病患者的中位生存时间长。Objective:To explore the clinical characteristics and prognosis of multiple myeloma(MM) patients with secondary primary malignancies.Methods:The clinical data of newly diagnosed MM patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2019 were retrospectively analyzed.The patients with secondary primary malignancies were retrieved,and their clinical features and prognosis were evaluated.Results:A total of 1 935 patients with newly diagnosed MM were admitted in this period,with a median age of 62(18-94) years old,of which 1 049 cases were hospitalized twice or more.There were eleven cases with secondary primary malignancies(the incidence rate was 1.05%),including three cases of hematological malignancies(2 cases of acute myelomonocytic leukemia and 1 case of acute promyelocytic leukemia) and eight cases of solid tumors(2 cases of lung adenocarcinoma,and 1 case each of endometrial cancer,esophageal squamous cell carcinoma,primary liver cancer,bladder cancer,cervical squamous cell carcinoma,and meningioma).The median age of onset was 57 years old.The median time between diagnosis of secondary primary malignancies and diagnosis of MM was 39.4 months.There were seven cases with primary or secondary plasma cell leukemia,the incidence rate was 0.67%,and the median age of onset was 52 years old.Compared with the randomized control group, the β2-microglobulin level in the secondary primary malignancies group was lower(P=0.028), and more patients were in stage Ⅰ/Ⅱ of ISS(P=0.029).Among the 11patients with secondary primary malignancies, one survived,ten died, and the median survival time was 40 months.The median survival time of MM patients after the secondary primary malignancies was only seven months.All seven patients with primary or secondary plasma cell leukemia died,with a median survival time of 14 months.The median overall survival time of MM patients with secondary primary malignancies was longer than that of the patients with plasma cell leukemia(P=0.027).C

关 键 词：多发性骨髓瘤 第二肿瘤 预后 

分 类 号：R733.3[医药卫生—肿瘤] R733.71[医药卫生—临床医学]