血清乳酸脱氢酶水平与初诊老年多发性骨髓瘤病人预后的相关性分析

目的探讨血清乳酸脱氢酶(LDH)与初诊老年多发性骨髓瘤(MM)临床指标的相关性及其预后意义。方法回顾性分析我院2009年7月至2016年1月年龄≥65岁的78例初诊老年MM病人的临床资料,并绘制病人的Kaplan-Meier生存曲线,分析初诊时血清LDH水平与病人预后的关系。根据病人的LDH水平分为LDH正常组和LDH升高组,并根据荧光原位杂交技术检测结果对60例资料完整的MM病人进行修正的国际分期系统(R-ISS)分期,比较其与国际分期系统(ISS)分期对预后判断的准确性。结果所有病人中位随访时间为16.5个月,初诊时LDH水平升高者占11.5%(9/78)。LDH正常组中位生存期(OS)和中位无进展生存期(PFS)分别为44.0个月、23.0个月,LDH升高组分别为14.0个月、12.0个月,2组间比较,差异有统计学意义(P<0.01)。COX多因素回归分析显示,LDH水平升高是老年MM病人OS的独立不良预后因素(HR=5.998,95%CI2.454~14.664,P<0.001)。另外,ISS分期Ⅱ期和Ⅲ期病人的中位OS差异无统计学意义(44.0个月比39.0个月,P=0.713),中位PFS差异也无统计学意义(26.0个月比20.0个月,P=0.569);而R-ISS分期Ⅱ期和Ⅲ期病人的中位OS差异有统计学意义(44.0个月比15.5个月,P<0.001),中位PFS差异无统计学意义(21.0个月比14.0个月,P=0.097)。结论LDH水平是判断老年MM病人预后的重要指标,基于其基础上的R-ISS分期在预后判断中要优于ISS分期。

Correlation analysis between serum lactate dehydrogenase and prognosis in elderly patients with newly diagnosed multiple myeloma

Objective To investigate the correlation between serum lactate dehydrogenase(LDH)and the clinical indicators in the elderly patients with newly diagnosed multiple myeloma(MM)and its prognostic significance.Methods The clinical data of 78 cases of newly diagnosed MM aged≥65 years old in our hospital from July 2009 to January 2016 were analyzed retrospectively.The relationship between serum LDH level and prognosis was analyzed by Kaplan-Meier survival curve.The revised International Staging System(R-ISS)staging of 60 MM patients with complete data was carried out based on the patient's LDH level and fluorescence in situ hybridization test result,and the accuracy of prognostic judgment was compared with the International Staging System(ISS)staging.Results The median follow-up time for all the patients was 16.5 months,and 11.5%(9/78)of the patients showed elevated LDH levels at the first visit.The median survival time(OS)of the normal LDH group was 44.0 months,compared with 14.0 months of the elevated LDH group(P<0.001);The median progression-free survival time(PFS)of the normal LDH group was 23.0 months,compared with 12.0 months of the elevated LDH group(P=0.006).COX multivariate regression analysis showed that elevated LDH level was an independent poor prognostic factor for OS in the elderly MM patients(HR=5.998,95%CI 2.454-14.664,P<0.001).There were no significant differences in median OS and median PFS between stageⅡandⅢof ISS(44.0 months vs 39.0 months,P=0.713;26.0 months vs 20.0 months,P=0.569),while there was significant difference in median OS(44.0 months vs 15.5 months,P<0.001),and no significant difference in median PFS(21.0 months vs 14.0 months,P=0.097)between stageⅡandⅢof R-ISS.Conclusions LDH level is an important indicator for judging the prognosis of the elderly MM patients.R-ISS staging based on LDH level is superior to ISS staging in predicting prognosis.