| 陈凤香,常进.R2-ISS风险分层在非移植初诊多发性骨髓瘤病人中的预后价值[J].安徽医药,2025,29(12):2470-2474. |
| R2-ISS风险分层在非移植初诊多发性骨髓瘤病人中的预后价值 |
| Prognostic value of R2-ISS risk stratification in non-transplanted patients with primary diagnosis of multiple myeloma |
| |
| DOI：10.3969/j.issn.1009-6469.2025.12.029 |
| 中文关键词: 多发性骨髓瘤 预后分层 1q21扩增 第二次修订的国际分期系统( R2-ISS) 细胞遗传学异常 |
| 英文关键词: Multiple myeloma Prognosis stratification 1q21 amplification Revised International Staging System (R2-ISS) Cy-togenetic abnormalities |
| 基金项目: |
|
| 摘要点击次数: 820 |
| 全文下载次数: 309 |
| 中文摘要: |
| 目的评估第二次修订的国际分期系统(R2-ISS)风险分层在非移植初诊多发性骨髓瘤( NDMM)病人中的预后价值。方法回顾性分析 2016年 1月至 2023年 1月山西省人民医院 172例非移植 NDMM病人的临床资料；根据 R2-ISS分期对不同亚组进行生存分析；比较一致性指数( C-index)值以评估不同分期系统的预后效能；通过 Cox回归模型分析影响多发性骨髓瘤(MM)病人预后的危险因素。结果在所有非移植 NDMM病人中， R2-ISS Ⅰ、R2-ISS Ⅱ、R2-ISS Ⅲ和 R2-ISS Ⅳ期的中位总生存期( OS)分别为尚未达到、尚未达到、 39.000(33.310，44.690)个月、 25.000(17.614，32.386)个月，提示 R2-ISS分期越高， OS越短，差异有统计学意义( P<0.001)； R2-ISS分期可有效预测修订的国际分期系统( R-ISS)Ⅱ期、梅奥骨髓瘤分层及风险调整治疗 3.0系统( mSMART 3.0)高危组和标危组病人的不同预后，不同分期病人 OS差异有统计学意义( P<0.05)； R-ISS、mSMART 3.0和 R2-ISS分期的 C-index值分别为 0.64、0.60和 0.68，体现了 R2-ISS分期的优越性；此外， R2-ISS分期在不同亚组(老年组( >65岁)和非老年组( ≤65岁)，血肌酐 ≥177 μmol/L组和血肌酐 <177 μmol/L组)中也能有效地评估病人预后差异(P<0.05)； Cox多因素结果显示乳酸脱氢酶、 R2-ISS中高危组、 R2-ISS高危组是影响 MM预后的独立危险因素。结论 R2-ISS分期系统的评估预后效能优于 R-ISS和 mSMART 3.0分期，能对非移植 NDMM病人进行更精准的风险分层，是 MM的不良预后因素。 |
| 英文摘要: |
| Objective To evaluate the prognostic value of risk stratification using the second revision of International Staging System (R2-ISS) in patients with non-transplant-eligible newly diagnosed multiple myeloma (NDMM).Methods A retrospective analysis was conducted of the clinical data of 172 non-transplanted patients with NDMM at Shanxi Provincial People's Hospital between January2016 and January 2023. Survival analysis was performed for different subgroups based on R2-ISS staging. The C-index values were compared to evaluate the prognostic efficacies of different staging systems. Cox regression models were used to analyze risk factors af-fecting the prognosis of multiple myeloma (MM) patients.Results Among all non-transplanted NDMM patients, the median overall sur-vival (OS) times for R2-ISS Stage Ⅰ, R2-ISS Stage Ⅱ, R2-ISS Stage Ⅲ, and R2-ISS Stage Ⅳ were not yet reached, not yet reached,39.000 (33.310, 44.690) months, and 25.000 (17.614, 32.386) months, with statistically significant differences (P<0.001), indicating the higher the RS-ISS staging, the shorter the OS. R2-ISS staging effectively predicted different prognoses for patients in the high-risk and standard-risk groups of the revised international staging system (R-ISS) stage Ⅱ, Mayo Myeloma Stratification and Risk-adjustedTreatment Stratification System 3.0 (mSMART 3.0). OS differences among patients with different staging were statistically significant (P <0.05). The C-index values for R-ISS, mSMART 3.0, and R2-ISS were 0.64, 0.60, and 0.68, respectively, demonstrating the superiority of R2-ISS staging. Furthermore, R2-ISS staging effectively assessed prognostic differences across subgroups [elderly group (aged >65 years) and non-elderly group (aged ≤65 years); group of serum creatinine ≥177 μmol/L and group of serum creatinine <177 μmol/L] (P< 0.05). Cox multivariate analysis revealed that lactate dehydrogenase (LDH), R2-ISS intermediate-high risk group, and R2-ISS high-risk group were independent risk factors affecting MM prognosis.Conclusion The R2-ISS staging system assesses prognostic efficacy bet-ter than R-ISS and mSMART 3.0 staging systems and enables more accurate risk stratification of non-transplanted NDMM patients, which is a poor prognostic factor for MM. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
