燃烧性骨髓瘤进展风险的时间趋势:系统性审查
Heinz Ludwig1, Efstathios Kastritis2, Sarah Bernhard1
1Wilhelminen Cancer Research Institute, First Department of Medicine, Center for Oncology, Hematology, and Palliative Care, Clinic Ottakring, Montlearstraße 37, 1160, Vienna, Austria.
EClinicalMedicine
|January 22, 2026
概括
燃烧多发性骨髓瘤 (SMM) 的预后有所改善,由于更好的诊断,近年来观察到的进展率较低. 这表明疾病的发展过程更加惰,有助于为患者做出有针对性的治疗决策.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 流行病学 流行病学
背景情况:
- 诊断的进步和分类的更新可能改变了燃烧多发性髓瘤 (SMM) 的自然历史.
- 缺乏对SMM预后这些时间变化的实证量化.
- 这项研究系统地审查了SMM预后的时间趋势.
研究的目的:
- 评估多发性骨髓瘤 (SMM) 预后的时间变化.
- 为了量化SMM自然历史的演变,以响应诊断和分类更新.
- 评估诊断精度对SMM随时间推移的进展率的影响.
主要方法:
- 对PubMed,EMBASE和Cochrane图书馆数据库的系统审查 (1990年1月至2025年11月).
- 使用Shiny网络应用程序对发布的时间到进展 (TTP) 曲线进行数字化,用于个人级数据重建.
- 使用RStudio.com生成卡普兰-梅尔 (KM) 存活曲线和元分析.
主要成果:
- 2年和10年的整体进展风险分别为22.8%和60.1%,高风险患者增加到44.7%和85.6%.
- 在第五年之后的里程碑分析显示,在2年和5年后的里程碑后,进展率减弱:14.2%和30.8% (全风险),22.5%和50.6% (高风险).
- 在2014年之前的研究显示,比最近的队列更高的进展率 (斯皮尔曼的rho = 0.645,p = 0.034),元分析支持老队列的进展率较高.
结论:
- 近年来,燃烧的多发性骨髓瘤 (SMM) 似乎遵循了一个更加惰的轨迹.
- 改进的诊断精度和排除亚临床疾病可能有助于这种观察到的惰性过程.
- 增强的预测模型可以指导治疗决策,将治疗针对高风险个体,避免对低风险患者进行不必要的干预.
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