R2-ISS分期在新诊断多发性骨髓瘤预后评估中的应用  

Application of the Second Revision of the International Staging System(R2-ISS)in the prognostic assessment of newly diagnosed multiple myeloma

作　　者：严婕 周东明 邵晓雁[2] 徐勇[2] 陈兵[1,2] Yan Jie;Zhou Dongming;Shao Xiaoyan;Xu Yong;Chen Bing(Department of Hematology,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210008,China;Department of Hematology,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院血液科,南京210008 [2]南京大学医学院附属鼓楼医院血液科,南京210008

出　　处：《中华血液学杂志》2024年第2期170-177,共8页Chinese Journal of Hematology

基　　金：国家自然科学基金(82273954、82000450)。

摘　　要：目的探讨R2-ISS(The Second Revision of the International Staging System)分期在新诊断多发性骨髓瘤(NDMM)患者中的预后价值。方法收集自2012年12月至2022年3月在南京医科大学鼓楼临床医学院血液科就诊的326例以免疫调节药物和(或)蛋白酶体抑制剂为一线治疗方案的NDMM患者临床资料,采用Kaplan-Meier法进行生存分析,Log-rank检验比较组间差异,Cox比例风险回归模型进行多因素分析。结果①326例NDMM患者中男性190例,中位年龄63岁,中位随访时间37个月。R2-ISS分期可进行有效的预后分层,特别是R-ISSⅡ期患者,R2-ISSⅠ期、Ⅱ期、Ⅲ期和Ⅳ期患者的中位无进展生存(PFS)期分别为52、29、20和15个月(P<0.001),中位总生存(OS)期分别为91、60、44和36个月(P<0.001)。多因素分析显示ISSⅡ期、ISSⅢ期、del(17p)、t(4;14)、1q^(+)、LDH升高、年龄>65岁是影响OS的独立不良预后因素;ISSⅡ期、ISSⅢ期、del(17p)、t(4;14)、1q^(+)、LDH升高是影响PFS的独立不良预后因素。②R2-ISS分期C-index得分为0.724,优于R-ISS分期的0.678,预测效能更高。③R2-ISSⅢ期和Ⅳ期中含1q^(+)在内的双打击患者中位PFS期分别为20、15个月(P=0.084),中位OS期为35、36个月(P=0.786)。Ⅲ期中含1q^(+)在内的双打击27例、1q^(+)单一异常61例、不含1q^(+)68例,三组的中位PFS期分别为20、18、21个月(P=0.974),中位OS期分别为35、47、56个月(P=0.042)。因此本研究将1q^(+)赋值调整至1,重新分组后R2-ISS不同分期的中位PFS期和OS期差异均有统计学意义(P<0.001)。结论R2-ISS分期预后分层价值优于R-ISS分期,特别是对异质性较强的R-ISSⅡ期人群,调整含1q^(+)在内的双打击赋值后可进一步优化R2-ISS分期。Objective To investigate the prognostic value of the Second Revision of the International Staging System(R2-ISS)in patients with newly diagnosed multiple myeloma(NDMM).Methods The retrospective study was performed in 326 NDMM patients with immunomodulatory drugs and/or proteasome inhibitors as the first-line treatment attending the Department of Hematology,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing,China,from December 2012 to March 2022.The Kaplan-Meier method was used for the survival analysis,with the Log-rank test comparing the between-group differences and Cox proportional risk regression modeling A multifactorial analysis was performed.Results①326 patients were included in the study,190 of whom were males.The median age was 63 years,and the median followup time was 37 months.R2-ISS can effectively predict prognosis,particularly for R-ISSⅡpatients.The median progression-free survival(PFS)time of R2-ISS Ⅰ,R2-ISSⅡ,R2-ISSⅢ,and R2-ISS IV was 52,29,20,and 15 months(P<0.001),while the median overall survival(OS)time was 91,60,44,and 36 months(P<0.001).Multifactor analysis revealed that ISSⅡ,ISSⅢ,del(17p),t(4;14),1q^(+),LDH increased,and age>65 years old were independent negative prognostic factors for OS.ISS Ⅱ,ISS Ⅱ,del(17p),t(4;14),1q^(+),and LDH were independent negative prognostic factors for PFS.②The C-index score of R2-ISS was 0.724,higher than that of R-ISS(0.678),indicating high prediction efficiency.③The median PFS for 1q^(+)-related double-hit in R2-ISSⅢ and Ⅳ were 20,15 months(P=0.084)and the median OS were 35,36 months(P=0.786),respectively.In R2-ISSⅢ,there were twenty-seven cases of 1q^(+)-related double-hit,sixty-one cases of 1q^(+)single abnormality,and sixty-eight cases with no 1q^(+).The median PFS for the three groups were 20,18,and 21 months(P=0.974),while the median OS was 35,47,and 56 months(P=0.042),respectively.Adjusting the assignment of 1q^(+)to 1,the median PFS and OS of different R2-ISS stages differed significantly after

关 键 词：多发性骨髓瘤 R2-ISS 1q21扩增 双打击 预后 

分 类 号：R733.3[医药卫生—肿瘤]