孤立性浆细胞瘤预后相关因素探究*

目的：探究孤立性浆细胞瘤患者的临床特点、治疗方法及预后相关因素。方法：搜集2000年6 月至2012年10月就诊于天津医科大学肿瘤医院的644 例恶性浆细胞肿瘤患者的临床资料，并对其临床特点、治疗方案、预后因素等进行分析，其中孤立性浆细胞瘤（solitary plasmacytoma ，SP）患者有66例占10.25% 。结果：根据SP的发生部位可分为骨孤立性浆细胞瘤（solitary bone plasmacytoma ，SBP ）和髓外浆细胞瘤（extramedullary plasmacytoma ，EMP ）。 SBP 大部分发生在椎体，而髓外浆细胞瘤好发于上呼吸道。此外，两者在肿块大小、血清M 蛋白水平、尿本周氏蛋白水平以及是否更易进展为多发性骨髓瘤（multiple myeloma，MM）等方面的差异均具有统计学意义（P < 0.05）。 多因素分析结果表明，SBP 患者的肿块越大（d≥ 5 cm），其肿瘤的局部控制率（local control ，LC）、无骨髓瘤进展生存期（multiple myeloma-freesurvival，MMFS）、总生存期（overall survival，OS）及无病进展生存期（progression-free survival ，PFS）越差；对于EMP 患者来说，放以及血清β 2- 微球蛋白< 3.5 mg/L 是预后良好的因素。结论：肿块大小、血清M 蛋白、尿本周氏蛋白、血清β 2- 微球蛋白水平可为临床判断SBP 与EMP 预后及指导治疗提供帮助。

Prognostic factors in solitary plasmacytoma

Objective:To investigate the clinical features, treatment strategies, and relative prognostic factors in 66 patients with solitary plasmacytoma (SP). Methods: The data of 644 patients, who were diagnosed with pathologically proven plasmacytoma in Tianjin Medical University Cancer Institute and Hospital between June 2000 and October 2012 , were collected. Sixty-six of these patients ( 10 .25 %) were evaluated as SP, including 45 solitary bone plasmacytoma (SBP) and 21 extramedullary plasmacytoma (EMP). Results:SBP and EMP were the two clinical subsets of SP revealing the location of the lesion. SBP mostly occurred in the axial skeleton, whereas EMP was most frequently observed in the upper respiratory tract. The differences among tumor size, serum M-protein, and serumβ 2-microglobulin exhibited statistical significance.Conclusion:Large tumor size (≥5 cm), positive serum M-protein, and serum β 2-microglobulin were the factors that affected the prognosis of SBP patients. Radiotherapy and serum β 2-microglobulin > 3.5 mg/L were the favorable prognostic factors for EMP patients.