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目的 :探讨治疗前外周血血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)与初诊时伴髓外病变(extramedullary disease,EMD)的多发性骨髓瘤患者临床病理特征的相关性,以及对预后的影响。方法 :回顾分析61例初诊时伴EMD的多发性骨髓瘤患者的临床病理特征、治疗效果、生存情况及预后。按中位PLR将患者分为低PLR组和高PLR组,观察PLR与患者临床病理特征及预后之间的关系。结果 :全组患者的PLR为45~273,中位值为128。低PLR组(≤128)30例,高PLR组(>128)31例。EMD最常见的受累部位依次为软组织、中枢神经系统、肺部、胸腹膜、皮肤和椎管;其他较少见的部位包括眼附属器、纵隔、乳腺、骨骼肌和卵巢。PLR与临床分期、β2微球蛋白、溶骨性病变数目和骨髓浆细胞比例相关(P值均<0.05)。全组患者的1、3和5年生存率分别为88.2%、62.2%和23.9%;治疗前低PLR组患者的1、3和5年生存率分别为96.4%、77.4%和57.4%,高PLR组患者的1、3和5年生存率分别为80.6%、49.9%和10.0%,差异有统计学意义(P=0.005)。单因素分析结果显示,β2微球蛋白(P=0.019)、溶骨性病变数目(P=0.049)以及接受治疗前外周血PLR(P=0.005)是影响患者预后的不良因素。COX多因素风险回归分析结果显示,仅PLR>128是独立的预后不良因素(P=0.029)。结论 :PLR作为一种简单、经济、可重复检测的全身炎性反应指标,对初诊时伴EMD的多发性骨髓瘤患者的预后评估具有一定的临床应用价值,治疗前高PLR提示此类疾病的预后可能不良。
Objective: To investigate the correlation between the pre-treatment peripheral blood platelet-to-lymphocyte ratio (PLR) and the clinicopathological features of multiple myeloma patients with extramedullary disease (EMD) The impact of prognosis. Methods: The clinical and pathological features, therapeutic effects, survival and prognosis of 61 patients with multiple myeloma with EMD newly diagnosed were retrospectively analyzed. According to the median PLR, patients were divided into low PLR group and high PLR group. The relationship between PLR and clinicopathological features and prognosis was observed. Results: The PLR of all patients was 45 to 273 with a median of 128. There were 30 cases in low PLR group (≤128) and 31 cases in high PLR group (> 128). The most common sites affected by EMD were soft tissue, central nervous system, lungs, chest and peritoneum, skin and spinal canal. Other less common sites included ocular adnexa, mediastinum, breast, skeletal muscle and ovary. PLR was associated with clinical stage, β2 microglobulin, osteolytic lesions and the proportion of bone marrow plasma cells (P <0.05). The 1-, 3-, and 5-year survival rates were 88.2%, 62.2% and 23.9% for the whole group, respectively. The 1, 3 and 5-year survival rates of patients with low PLR before treatment were 96.4%, 77.4% and 57.4% The 1-, 3-, and 5-year survival rates of patients in the PLR group were 80.6%, 49.9% and 10.0%, respectively, with significant differences (P = 0.005). Univariate analysis showed that β2 microglobulin (P = 0.019), the number of osteolytic lesions (P = 0.049), and pretreatment peripheral blood PLR (P = 0.005) were the adverse factors affecting the prognosis of patients. COX multivariate risk regression analysis showed that only PLR> 128 was an independent prognostic factor (P = 0.029). CONCLUSIONS: PLR, as a simple, economical and repeatable systemic inflammatory response indicator, has clinical value in the prognosis evaluation of patients with multiple myeloma with EMD when newly diagnosed. The high PLR before treatment suggests that these diseases Prognosis may be poor.