Presenting Signs of Multiple Myeloma and the Effect of Diagnostic Delay on the Prognosis
Presenting Signs of Multiple Myeloma and the Effect of Diagnostic Delay on the Prognosis
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DOI：
10.3122/jabfm.2016.06.150393
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发表时间：
2016-01-01
影响因子：
2.9
通讯作者：
Paltiel, Ora
中科院分区：
文献类型：
--
作者：
Goldschmidt, Neta;Zamir, Leora;Paltiel, Ora
背景：多发性骨髓瘤（MM）的症状是模糊和非特异性的。早期发现对初级保健的诊断提出了挑战。我们评估了临床和实验室数据是否可以为MM诊断提供早期线索，以及发现时间是否影响生存。方法：一项基于人群的回顾性研究，包括2002年至2011年间诊断为MM的110名男性和女性，以及以背痛为症状的无癌对照。临床和实验室数据从诊断MM/背痛主诉前2年的医疗记录中提取。结果：在诊断前的两年中，64 (58%)MM患者抱怨背部疼痛，37（34%）患有疲劳或体重减轻。病例-对照比较未显示在两年的诊断前期间疼痛主诉或感染的数量有任何显著差异。然而，疲劳或体重减轻、贫血、ESR和肌酐升高（均p < 0.001）在MM患者中发生的频率高于对照组，并在多变量分析中被证实为独立预测因子。TTD不影响诊断阶段、生存率和死亡率。结论：背部疼痛伴有疲劳、体重减轻或实验室结果异常应引起MM的“危险信号”警告。尽管如此，我们没有发现证据表明TTD影响MM的初始阶段或预后。
Background: Presenting symptoms of multiple myeloma (MM) are vague and nonspecific. Early detection poses a diagnostic challenge in primary care. We assessed whether clinical and laboratory data could provide early clues to MM diagnosis and whether time to detection affects survival.Methods: A retrospective population-based study, including 110 men and women diagnosed with MM between 2002 and 2011, and matched cancer-free controls presenting with back pain. Clinical and laboratory data were extracted from medical records for the 2-year period prior to diagnosis of MM/back pain complaint.Results: During the two years prior to diagnosis 64 (58%) of MM patients complained of back pain, and 37 (34%) suffered from fatigue or weight loss. Case-control comparisons did not reveal any significant differences in the number of pain complaints or infections in the two-year prediagnostic period. However, fatigue or weight loss, anemia, elevated ESR and creatinine (p < 0.001 for all) occurred more frequently in MM patients than controls and were confirmed as independent predictors in multivariated analysis. TTD did not impact stage at diagnosis, survival, or mortality.Conclusions: Back pain accompanied by fatigue, weight loss or abnormal lab results should raise a "red flag" warning of MM. Nonetheless, we did not find evidence that TTD influences the initial stage or the prognosis of MM.