Use of Nonclonal Serum Immunoglobulin Free Light Chains to Predict Overall Survival in the General Population
Use of Nonclonal Serum Immunoglobulin Free Light Chains to Predict Overall Survival in the General Population
复制标题
DOI：
10.1016/j.mayocp.2012.03.009
复制
发表时间：
2012-06-01
影响因子：
8.9
通讯作者：
Rajkumar, S. Vincent
中科院分区：
文献类型：
--
作者：
Dispenzieri, Angela;Katzmann, Jerry A.;Rajkumar, S. Vincent
目的：为了确定是否游离轻链（FLC）检测提供预后信息相关的一般population.Methods：排除已知的浆细胞疾病的人后，我们研究了15,859奥姆斯特德县，明尼苏达州，居民50岁或以上，其中未掩蔽的数据和样本FLC测试可用。在1995年3月13日至2003年11月21日期间获得基线信息，并确定随访状态和死亡原因，直至2009年6月30日。评价了kappa和lambda FLC总和（Sigma FLC）预测总生存期的能力。结果：在158，003人年的随访中，4348人死亡。高Sigma FLC显著预测总生存率较差;相对于其余研究参与者，Sigma FLC最高十分位数（即，>= 4.72 mg/dL）的死亡风险比为4.4（95%置信区间，4.1-4.7）。多变量分析表明，死亡的额外风险与年龄、性别和肾功能不全无关，校正风险比为2.1（95%置信区间，1.9-2.2）。死亡率的增加并不局限于任何特定的死亡原因，因为在先前的Sigma FLC为4.72 mg/dL或更高的个体中，大多数原因导致的预期死亡风险显著更高，这接近测试的正常上限。在无浆细胞疾病的一般人群中，Sigma FLC的非克隆性升高是总生存期较差的重要预测因子。(C)2012马约医学教育和研究基金会马约临床学报2012; 87（6）：517-523
Objective: To determine whether the free light chain (FLC) assay provides prognostic information relevant to the general population.Methods: After excluding persons with a known plasma cell disorder, we studied 15,859 Olmsted County, Minnesota, residents 50 years or older in whom unmasked data and samples for FLC testing were available. Baseline information was obtained between March 13, 1995, and November 21, 2003, and follow-up status and cause of death were identified through June 30, 2009. The kappa and lambda FLC sum (Sigma FLC) was evaluated for its ability to predict overall survival. Specific causes of death were also investigated.Results: In 158,003 person-years of follow-up, 4348 individuals died. A high Sigma FLC was significantly predictive of worse overall survival; the risk ratio for death for those with the highest decile of Sigma FLC (ie, >= 4.72 mg/dL) was 4.4 (95% confidence interval, 4.1-4.7) relative to the remaining study participants. Multivariate analyses demonstrated that this excess risk of death was independent of age, sex, and renal insufficiency, with a corrected risk ratio of 2.1 (95% confidence interval, 1.9-2.2). The increased mortality was not restricted to any particular cause of death because the observed-to-expected risk of death from most causes was significantly higher among those individuals with an antecedent Sigma FLC of 4.72 mg/dL or higher, which is near the upper limit of normal for the test.Conclusion: A nonclonal elevation of Sigma FLC is a significant predictor of worse overall survival in the general population of persons without plasma cell disorders. (C) 2012 Mayo Foundation for Medical Education and Research Mayo Clin Proc. 2012; 87(6): 517-523