Determining the Clinical Significance of Monoclonal Gammopathy of Undetermined Significance: A SEER-Medicare Population Analysis
Determining the Clinical Significance of Monoclonal Gammopathy of Undetermined Significance: A SEER-Medicare Population Analysis
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DOI：
10.1016/j.clml.2014.09.004
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发表时间：
2015-03-01
影响因子：
2.7
通讯作者：
Neuner, Joan M.
中科院分区：
文献类型：
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作者：
Go, Ronald S.;Gundrum, Jacob D.;Neuner, Joan M.
对未确定意义单克隆γ病（MGUS）患者进行随访检查以筛查恶性转化是一种常见做法；然而，缺乏证据。我们基于人群的研究表明，在癌症诊断前1年进行MGUS随访检查的多发性骨髓瘤、瓦尔登斯特罗姆巨球蛋白血症和淋巴浆细胞性淋巴瘤患者，与没有进行此类随访的患者相比，可能有更少的主要并发症和更长的生存期。背景：临床指南建议对大多数意义不明的单克隆γ病（MGUS）患者每年进行随访检查；然而，缺乏支持这种做法的证据。我们进行了一项基于人群的研究，以检查多发性骨髓瘤、瓦尔登斯特罗姆巨球蛋白血症和淋巴浆细胞性淋巴瘤（单克隆伽玛病相关恶性肿瘤）患者的疾病表现模式和结果，并比较有或没有既往MGUS随访检查的患者。材料和方法：从1994年到2007年，使用监测、流行病学和最终结果医疗保险相关数据库确定单克隆伽玛病相关恶性肿瘤患者，并将其分为2组：随访组（诊断前MGUS随访检查）和无随访组（无随访检查）。我们比较了结果，包括癌症诊断时的主要并发症（急性肾损伤、脐带压迫、透析使用、骨折和高钙血症）和生存率，使用倾向评分调整和Cox比例风险模型。所有统计检验均为双侧检验。结果：在17457例研究患者中，6%接受了MGUS随访。多变量建模后，随访组诊断时主要并发症明显减少（优势比0.68；95%可信区间[CI]， 0.57-0.80），特定疾病（中位数，38个月vs. 29个月，P < 0.001；风险比[HR] 0.85; 95% CI, 0.76-0.94）和总体（中位数，23个月vs. 19个月，P < 0.001; HR 0.87; 95% CI, 0.80-0.95）生存率更好。结论：在单克隆伽玛病相关恶性肿瘤诊断前进行MGUS随访的患者比未进行此类随访检查的患者出现的主要并发症更少，生存期更长。未来的研究将在非医保人群中复制我们的发现，并确定MGUS随访的最佳计划和成本效益。
The follow-up examination of patients with monoclonal gammopathy of undetermined significance (MGUS) to screen for malignant transformation is a common practice; however, evidence is lacking. Our population-based study has shown that patients with multiple myeloma, Waldenstrom macroglobulinemia, and lymphoplasmacytic lymphoma who had MGUS follow-up examinations 1 year before a cancer diagnosis might have fewer major complications and longer survival compared with those without such follow-up.Background: Clinical guidelines have recommended annual follow-up examinations of most patients with monoclonal gammopathy of undetermined significance (MGUS); however, evidence supporting this practice is lacking. We performed a population-based study to examine the patterns of disease presentation and outcomes of patients with multiple myeloma, Waldenstrom macroglobulinemia, and lymphoplasmacytic lymphoma (monoclonal gammopathy associated malignancies) comparing those with or without a previous MGUS follow-up examination. Materials and Methods: Patients with monoclonal gammopathy-associated malignancy from 1994 through 2007 were identified using the Surveillance, Epidemiology, and End Results Medicare linked database and divided into 2 cohorts: those with follow-up (MGUS follow-up examination preceding the diagnosis) and those with no follow-up (no such follow-up examination). We compared the outcomes, including the rates of major complications at cancer diagnosis (acute kidney injury, cord compression, dialysis use, fracture, and hypercalcemia) and survival using propensity score adjustment and Cox proportional hazard models. All statistical tests were 2-sided. Results: Of the 17,457 study patients, 6% had undergone MGUS follow-up. After multivariable modeling, the follow-up group had significantly fewer major complications at diagnosis (odds ratio 0.68; 95% confidence interval [CI], 0.57-0.80) and better diseasespecific (median, 38 vs. 29 months, P < .001; hazard ratio [HR] 0.85; 95% CI, 0.76-0.94) and overall (median, 23 vs. 19 months, P < .001; HR 0.87; 95% CI, 0.80-0.95) survival. Conclusion: Patients with MGUS follow-up preceding the diagnosis of a monoclonal gammopathy associated malignancy can experience fewer major complications and have longer survival than those without such follow-up examinations. Future studies replicating our findings in the nonMedicare population and determining the optimal schedule and cost-effectiveness of MGUS follow-up are warranted.