The revised international staging system (R-ISS) in multiple myeloma (MM) was recently updated as the second R-ISS (R2-ISS) and refined prognostication in clinical trial populations. By including 2929 Danish patients with MM and complete data on R2-ISS registered from 2005 through 2019, we validated the R2-ISS for overall survival (OS) in a population-based cohort; however, only partly among younger patients. We thus developed a real-world international staging system (RW-ISS) from a 75% training cohort. Feature selection and weighted scores of high-risk variables from a Cox regression model of OS included age >70 years (2 points), performance status (PS) > 1 (2 points), PS 1 (1 point), t(14;16) (1 point), ISS III (1 point), ISS II (0.5 points), high lactate dehydrogenase (0.5 points), and del(17p) (0.5 points). In the test set, patients with RW-ISS I (0–2.0 points, 38.2%), II (2.5–3.0 points, 19.8%), III (3.5–4.5 points, 27.1%), and IV (5.0–7.0 points, 15.0%) demonstrated a median OS of 9.5, 5.5, 3.4, and 1.1 years, respectively (P < 0.0001) and the C-index was superior for RW-ISS as compared to both R2-ISS and R-ISS (0.708 vs 0.604 vs 0.595, respectively). RW-ISS was in part externally validated. We thus recommend using RW-ISS in routine clinical care of NDMM.
多发性骨髓瘤（MM）修订版国际分期系统（R-ISS）近期更新为第二版R-ISS（R2-ISS），并在临床试验人群中优化了预后分层。我们基于2005年至2019年期间登记的2929例丹麦MM患者完整R2-ISS数据，在基于人群的队列中验证了R2-ISS对总生存期（OS）的预测价值，但在年轻患者中仅部分适用。为此，我们利用75%的训练队列开发了真实世界国际分期系统（RW-ISS）。通过OS的Cox回归模型进行特征筛选和高危变量加权评分，包括：年龄>70岁（2分）、体能状态（PS）>1（2分）、PS=1（1分）、t(14;16)易位（1分）、ISS III期（1分）、ISS II期（0.5分）、高乳酸脱氢酶（0.5分）以及del(17p)缺失（0.5分）。在测试集中，RW-ISS I期（0–2.0分，占38.2%）、II期（2.5–3.0分，占19.8%）、III期（3.5–4.5分，占27.1%）和IV期（5.0–7.0分，占15.0%）患者的中位OS分别为9.5年、5.5年、3.4年和1.1年（P<0.0001），且RW-ISS的C-index优于R2-ISS和R-ISS（分别为0.708 vs 0.604 vs 0.595）。RW-ISS已得到部分外部验证。因此我们推荐在新诊断多发性骨髓瘤（NDMM）的常规临床诊疗中应用RW-ISS。
肿瘤(癌症)患者之家