A new staging system for multiple myeloma patients based on the Southwest Oncology Group (SWOG) experience
A new staging system for multiple myeloma patients based on the Southwest Oncology Group (SWOG) experience
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DOI：
10.1046/j.1365-2141.2003.04456.x
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发表时间：
2003-08-01
影响因子：
6.5
通讯作者：
Crowley, JJ
中科院分区：
文献类型：
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作者：
Jacobson, JL;Hussein, MA;Crowley, JJ
我们的目标是根据容易获得的实验室测量结果开发和评估多发性骨髓瘤 (MM) 分期系统。 Durie-Salmon 阶段最常用，是临床试验研究的有效患者分层系统。然而，标准很复杂，需要许多实验室参数才能对患者进行正确分期。在本分析中，我们重点关注对 MM 预后具有重要意义的两种常见指标：血清 β2 微球蛋白 (β2m) 和血清白蛋白。分析中使用了 1555 名先前未接受治疗的多发性骨髓瘤患者的预研究数据，这些患者最近参加了四项西南肿瘤学组 (SWOG) III 期试验。使用回归树方法开发和验证生存结果的分期模型。 SWOG分期定义为：1期，β2m < 2.5 mg/l（14%的患者，中位总生存期为55个月）； 2期，2.5小于或等于beta2m < 5.5（43%的患者，中位总生存期为40个月）； 3期，β2m大于或等于5.5且白蛋白大于或等于30 g/l（32%的患者，中位总生存期为24个月）； 4 期，β2m 大于或等于 5.5，白蛋白 < 30 g/l（11% 的患者，中位总生存期为 16 个月）。该分期方案还可以预测无事件生存期、第一年死亡率和长期（大于或等于 5 年）无事件生存期。我们的结论是，虽然 SWOG 分期并不代表 MM 的新预后标志物（细胞遗传学、FISH），但它可以为先前未经治疗的 MM 患者提供 Durie-Salmon 分期的简单替代方案。需要对其他 MM 患者群体进行额外评估来确认结果。
We aimed to develop and evaluate a staging system for multiple myeloma (MM) based on easily obtained laboratory measures. The Durie-Salmon stage is most commonly used and is an effective system of patient stratification for clinical trial research. However, the criteria are complex and many laboratory parameters are required to properly stage patients. In this analysis, we focused on two common measures with prognostic importance in MM: serum beta2 microglobulin (beta2m) and serum albumin. Pre-study data on 1555 previously untreated MM patients enrolled on four recent South-west Oncology Group (SWOG) phase III trials were used in the analysis. Staging models were developed and validated using regression tree methods for survival outcomes. SWOG stages were defined as: stage 1, beta2m < 2.5 mg/l (14% of patients, median overall survival of 55 months); stage 2, 2.5 less than or equal to beta2m < 5.5 (43% of patients, median overall survival of 40 months); stage 3, beta2m greater than or equal to 5.5 and albumin greater than or equal to 30 g/l (32% of patients, median overall survival of 24 months); and stage 4, beta2m greater than or equal to 5.5 and albumin < 30 g/l (11% of patients and median overall survival of 16 months). This staging scheme was also predictive of event-free survival, first-year mortality and long-term (greater than or equal to 5 years) event-free survival. We conclude that although the SWOG stage does not represent a new prognostic marker for MM (cytogenetics, FISH), it could provide a simple alternative to the Durie-Salmon stage for patients with previously untreated MM. Additional evaluation in other MM patient populations is needed to confirm results.