Objective: To investigate the influence of rFLC and dFLC on clinical prognosis and best cutoff value in patients with newly diagnosed multiple myelome(MM).
Methods: Clinical data of 240 patients with newly diagnosed MM treated in Western Theater General Hospital of People's Liberation Army from January 2010 to June 2016 were collected and retroanalyzed. All patients were divided into different groups according to the interquartile spacing levels of rFLC and dFLC, the median OS and PFS of patients in different groups were compared. The influencing factors of prognosis in newly diagnosed MM patients were analyzed by univariate and multivariate methods, the influence of different cutoff values of rFLC and dFLC on clinical prognosis were evaluated.
Results: The median progression-free survival time of female patients with M-protein IgA type and I stage for ISS stage were significantly longer than those of male, other M-protein types and other ISS stage（P<0.05）. The median OS of patients without hypercalcemia was significantly higher than that of patients with hypercalcemia（P<0.05）. The median progression-free survival(PFS) time of patients with dFLC <110.95 mg/L was significantly longer than that of patients with dFLC=110.95-2 781.44 mg/L and >2 781.44 mg/L（P<0.05）. The median overall survival time of patients with dFLC ＜110.95 mg/L and ＞2 781.44 mg/L was significantly longer than that of patients with dFLC=110.95-2 781.44 mg/L（P<0.05）. The median overall survival time of patients with rFLC <14.71 mg/L was significantly longer than that of patients with rFLC >14.71-367.96 mg/L and >367.96 mg/L（P<0.05）. Univariate analysis of Cox regression model indicated that dFLC at all levels showed higher influence on the OS and PFS of patients as compared with rFLC（P<0.05）. Multivariate analysis of Cox regression model showed that rFLC and dFLC expression level were the independent prognostic factors of patients（P<0.05）. The most significant influence value on clinical prognosis of patients were observed when rFLC level ≤14.71 or dFLC level ≤110.95 mg/L（P<0.05）. The median OS of patients with rFLC level ≤14.71 was significantly higher than that of other groups（P<0.05）. There was significant difference in median PFS between patients with rFLC ≤14.71 and ≥367.96 mg/L（P<0.05）. The median OS and PFS of patients with dFLC ≤110.95 mg/L were significantly longer than those in other two groups（P<0.05）.
Conclusion: The levels of rFLC and dFLC closely relate to clinical prognosis of patients with new diagnosed MM; the risk of recurrence or death is lowest in patients with rFLC level ≤14.71 mg/L or dFLC level ≤110.95 mg/L, which can be used as the ideal cutoff value for prognosis evaluation.
题目: rFLC和dFLC对初治多发性骨髓瘤患者临床预后的影响及最佳cutoff值探讨.
目的: 探讨游离轻链比值（rFLC）和游离轻链差值（dFLC）对初治多发性骨髓瘤（MM）患者临床预后的影响及最佳截断（cutoff）值.
方法: 收集并回顾性分析2010年1月-2016年6月在中国人民解放军西部战区总医院治疗的240例初治MM患者的临床资料，根据rFLC和dFLC四分位间距水平分组，比较不同组中位总生存时间和中位无进展生存时间，采用单因素和多因素分析其预后影响因素，同时评估rFLC和dFLC不同cutoff值对患者预后的影响.
结果: 女性、M蛋白分型IgA型及ISS分期I期患者的中位无进展生存时间均显著长于男性、其他M蛋白类型及ISS分期患者（P<0.05）；未合并高钙血症患者的中位总生存时间显著优于合并高钙血症患者（P<0.05）。dFLC＜110.95 mg/L患者的中位无进展生存时间显著长于110.95-2 781.44 mg/L、＞2 781.44 mg/L患者（P<0.05）； dFLC＜110.95 mg/L和＞2 781.44 mg/L患者的中位总生存时间显著长于110.95-2 781.44 mg/L患者（P<0.05）； rFLC＜14.71 mg/L患者的中位总生存时间显著长于14.71-367.96 mg/L、＞367.96 mg/L患者（P<0.05）。Cox回归模型单因素分析结果显示，dFLC各表达水平对初治MM患者的总生存时间和无进展生存时间影响较rFLC更高（P<0.05）。Cox回归模型多因素分析结果提示，rFLC和dFLC水平均是患者临床预后的独立影响因素（P<0.05）。当rFLC水平≤14.71或dFLC水平≤110.95 mg/L时，对于初治MM患者预后影响最为显著；rFLC水平≤14.71 mg/L患者的中位总生存时间显著优于其他组（P<0.05）；rFLC≤14.71和≥367.96 mg/L患者的中位无进展生存时间比较差异有统计学意义（P<0.05）；同时，dFLC≤110.95 mg/L患者的中位总生存时间和无进展生存时间均显著优于其他2组（P<0.05）.
结论: rFLC和dFLC水平与初治MM患者临床预后密切相关；其中rFLC水平≤14.71或dFLC水平≤110.95 mg/L时患者复发或死亡风险最低，可作为预后评估理想的cutoff值.