In myelofibrosis, comorbidities (CMs) add prognostic information independently from the Dynamic International Prognostic Scoring System (DIPSS). The Myelodysplastic Syndrome-Specific Comorbidity Index (MDS-CI) offers a simple tool for CM assessment as it is calculable after having performed a careful history and physical examination, a small routine chemistry panel (including creatinine and liver enzymes) and a limited set of functional diagnostics. To assess the prognostic impact of the MDS-CI in addition to the DIPSS and the Mutation-Enhanced International Prognostic Scoring System (MIPSS)-70, we performed a retrospective chart review of 70 MF patients who had not received allogeneic stem cell transplantation (primary MF, n = 51; secondary MF, n = 19; median follow-up, 40 months) diagnosed at our institution between 2000 and 2020. Cardiac diseases (23/70) and solid tumors (12/70) were the most common CMs observed at MF diagnosis. Overall survival (OS) was significantly influenced by the MDS-CI (median OS MDS-CI low (n = 38): 101 months; MDS-CI intermediate (n = 25): 50 months; and high (n = 7): 8 months;p< 0.001). The MDS-CI added prognostic information after inclusion as a categorical variable in a multivariate model together with the dichotomized DIPSS or the dichotomized MIPSS70: MDS-CI high HR 14.64 (95% CI 4.42; 48.48),p= 0.0002, and MDS-CI intermediate HR 1.97 (95% CI 0.96; 4.03),p= 0.065, and MDS-CI high HR 19.65 (95% CI 4.71; 81.95),p< 0.001, and MDS-CI intermediate HR 1.063 (95% CI 0.65; 4.06),p= 0.2961, respectively. The analysis of our small and retrospective MF cohort suggests that the MDS-CI represents a useful tool to identify MF patients with an increased vulnerability due to comorbidities. However, analyses of larger cohorts are necessary to define the value of the MDS-CI as a prognostic tool in comparison with other comorbidity indices.
在骨髓纤维化中，合并症为预后评估提供了独立于动态国际预后评分系统的额外信息。骨髓增生异常综合征特异性合并症指数作为一种简便的合并症评估工具，可通过详细病史采集、体格检查、基础生化检测（包括肌酐和肝酶）及有限的功能诊断检查进行计算。为评估MDS-CI在DIPSS和突变增强国际预后评分系统-70基础上的预后价值，我们对2000年至2020年间在本机构确诊的70例未接受异基因干细胞移植的骨髓纤维化患者（原发性骨髓纤维化51例，继发性骨髓纤维化19例；中位随访时间40个月）进行了回顾性病历分析。心脏疾病（23/70）和实体肿瘤（12/70）是骨髓纤维化诊断时最常见的合并症。MDS-CI对总生存期具有显著影响（MDS-CI低危组38例中位OS为101个月；中危组25例为50个月；高危组7例为8个月；p<0.001）。将MDS-CI作为分类变量纳入多变量模型后，其与二分类DIPSS或二分类MIPSS70共同提供了额外的预后信息：MDS-CI高危组风险比14.64（95%置信区间4.42-48.48，p=0.0002），中危组风险比1.97（95%置信区间0.96-4.03，p=0.065）；以及MDS-CI高危组风险比19.65（95%置信区间4.71-81.95，p<0.001），中危组风险比1.063（95%置信区间0.65-4.06，p=0.2961）。本小型回顾性骨髓纤维化队列分析表明，MDS-CI可作为识别因合并症导致预后不良的骨髓纤维化患者的有效工具。然而，仍需通过更大规模队列分析来明确MDS-CI相较于其他合并症指数作为预后评估工具的价值。
肿瘤(癌症)患者之家