文章：

合并症作为多发性骨髓瘤的预后变量：常见合并症评分与新型MM合并症评分的比较评价

Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM–comorbidity score

原文发布日期：2011-09-16

DOI: 10.1038/bcj.2011.34

类型: Original Article

开放获取: 是

英文摘要：

Comorbidities have been demonstrated to affect progression-free survival (PFS) and overall survival (OS), although their impact in multiple myeloma (MM) patients is as yet unsettled. We (1) assessed various comorbidities, (2) compared established comorbidity indices (CIs; Charlson comorbidity index (CCI), hematopoietic cell transplantation-specific comorbidity index (HCT-CI)), Kaplan Feinstein (KF) and Satariano index (SI) and (3) developed a MM-CI (Freiburger comorbidity index, FCI) in 127 MM patients. Univariate analysis determined moderate or severe pulmonary disease (hazard ratio (HR): 3.5, P<0.0001), renal impairment (via estimated glomerular filtration rate (eGFR); HR: 3.4, P=0.0018), decreased Karnofsky Performance Status (KPS, HR: 2.7, P=0.0004) and age (HR: 2, P=0.0114) as most important variables for diminished OS. Through multivariate analysis, the eGFR ⩽30 ml/min/1.73m2, impaired lung function and KPS ⩽70% were significant for decreased OS, with HRs of 2.9, 2.8 and 2.2, respectively. Combination of these risk factors within the FCI identified significantly different median OS rates of 118, 53 and 25 months with 0, 1 and 2 or 3 risk factors, respectively, (P<0.005). In light of our study, comorbidities are critical prognostic determinants for diminished PFS and OS. Moreover, comorbidity scores are important treatment decision tools and will be valuable to implement into future analyses and clinical trials in MM.

摘要翻译： 

合并症已被证实会影响无进展生存期（PFS）和总生存期（OS），但其对多发性骨髓瘤（MM）患者的影响尚未明确。我们（1）评估了127例MM患者的各种合并症，（2）比较了既定的合并症指数（CIs；查尔森合并症指数（CCI）、造血细胞移植特异性合并症指数（HCT-CI）、卡普兰-范斯坦指数（KF）和萨塔里亚诺指数（SI），并（3）开发了MM特异性合并症指数（弗莱堡合并症指数，FCI）。单变量分析确定中度或重度肺部疾病（风险比（HR）：3.5，P<0.0001）、肾功能损害（通过估算肾小球滤过率（eGFR）；HR：3.4，P=0.0018）、卡氏功能状态评分降低（KPS，HR：2.7，P=0.0004）和年龄（HR：2，P=0.0114）是导致OS缩短的最重要变量。通过多变量分析，eGFR⩽30 ml/min/1.73m²、肺功能受损和KPS⩽70%对OS缩短具有显著性意义，HR值分别为2.9、2.8和2.2。将这些风险因素结合在FCI中，发现具有0、1和2或3个风险因素的患者中位OS存在显著差异，分别为118、53和25个月（P<0.005）。根据我们的研究，合并症是PFS和OS缩短的关键预后决定因素。此外，合并症评分是重要的治疗决策工具，对于未来MM的分析和临床试验具有重要价值。

原文链接：

Comorbidity as a prognostic variable in multiple myeloma: comparative evaluation of common comorbidity scores and use of a novel MM–comorbidity score