基于2016 WHO分型和IPSS-R危险分层的老年骨髓增生异常综合征分析
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摘要
目的分析老年骨髓增生异常综合征(myelodysplastic syndromes,MDS)病人的临床特征,比较2016和2008世界卫生组织(World Health Organization,WHO)分型标准,国际预后积分系统(International Prognostic ScoringSystem,IPSS)和修订后的IPSS(Revised IPSS,IPSS-R)之间的差异。方法将111例初发MDS病人分成老年组(≥60岁)和非老年组(<60岁),分别对2组病人同时按2016 WHO分型标准和2008 WHO分型标准进行分型,并对2组病人依据IPSS和IPSS-R积分系统进行预后评分,比较2016和2008 WHO分型标准,IPSS和IPSS-R之间的差异,并比较2组病人在各临床指标、实验室参数之间的差异。结果对于本组MDS病人,2016 WHO分型标准更加完善,IPSS-R积分系统可更好地识别部分高危的病人;老年组病人IPSS-R危险度分层极高危的比例明显高于非老年组病人,差异有统计学意义(P<0. 05);与非老年组比较,7号染色体异常在老年组检出比例更高,差异有统计学意义(P<0. 05);老年组MDS病人血小板计数、血尿素氮和肌酐水平明显高于非老年组病人(均P<0. 05)。结论 2016 WHO分型标准和IPSS-R积分系统对MDS病人的分型、危险度分层更精准;老年MDS病人预后差于非老年病人。
Objective To explore the characteristics of elderly patients with myelodysplastic syndromes( MDS) and to compare the differences between 2016 and 2008 WHO classification,International Prognostic Scoring System( IPSS) and Revised IPSS( IPSS-R). Methods A total of 111 newly diagnosed patients were divided into elderly group and non-elderly group. The differences in WHO classification,IPSS risk category,clinical and laboratory parameters were compared between the two groups. Results 2016 WHO classification was better and more standard than 2008 WHO classification.IPSS-R could identify some high-risk patients efficiently. Abnormalities of chromosome 7 were more frequently detected in elderly group( P< 0. 05). Based on IPSS-R,the rate of patients with extremely high-risk was higher in elderly group than that in non-elderly group( P< 0. 05). The levels of blood urea nitrogen,creatinine and platelet in elderly group was higher than those in non-elderly group( P<0. 05).Conclusions 2016 WHO classification and IPSS-R are more efficient for MDS patients. Elderly MDS patients have inferior prognosis compared to non-elderly patients.
Objective To explore the characteristics of elderly patients with myelodysplastic syndromes( MDS) and to compare the differences between 2016 and 2008 WHO classification,International Prognostic Scoring System( IPSS) and Revised IPSS( IPSS-R). Methods A total of 111 newly diagnosed patients were divided into elderly group and non-elderly group. The differences in WHO classification,IPSS risk category,clinical and laboratory parameters were compared between the two groups. Results 2016 WHO classification was better and more standard than 2008 WHO classification.IPSS-R could identify some high-risk patients efficiently. Abnormalities of chromosome 7 were more frequently detected in elderly group( P< 0. 05). Based on IPSS-R,the rate of patients with extremely high-risk was higher in elderly group than that in non-elderly group( P< 0. 05). The levels of blood urea nitrogen,creatinine and platelet in elderly group was higher than those in non-elderly group( P<0. 05).Conclusions 2016 WHO classification and IPSS-R are more efficient for MDS patients. Elderly MDS patients have inferior prognosis compared to non-elderly patients.
引文
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[2]Tefferi A,Vardiman JW.Myelodysplastic syndromes[J].NEngl J Med,2009,361(19):1872-1885.
[3]Vardiman JW,Thiele J,Arber DA,et al.The 2008 revision of the World Health Organization(WHO)classification of myeloid neoplasms and acute leukemia:rationale and important changes[J].Blood,2009,114(5):937-951.
[4]Arber DA,Orazi A,Hasserjian R,et al.The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia[J].Blood,2016,127(20):2391-2405.
[5]Greenberg P,Cox C,Lebeau MM,et al.International scoring system for evaluating prognosis in myelodysplastic syndromes[J].Blood,1997,89(6):2079-2088.
[6]Greenberg PL,Tuechler H,Schanz J,et al.Revised international prognostic scoring system for myelodysplastic syndromes[J].Blood,2012,120(12):2454-2465.
[7]Liu P,Lin Z,Qian S,et al.Expression of dominantnegative Ikaros isoforms and associated genetic alterations in Chinese adult patients with leukemia[J].Ann Hematol,2012,91(7):1039-1049.
[8]Li M,Xiao L,Xu J,et al.Co-existence of PHF6 and NOTCH1 mutations in adult T-cell acute lymphoblastic leukemia[J].Oncol Lett,2016,12(1):16-22.
[9]Ganguly BB,Kadam NN.Mutations of myelodysplastic syndromes(MDS):An update[J].Mutat Res Rev Mutat Res,2016,769:47-62.
[10]Greenberg PL.Myelodysplastic syndromes:dissecting the heterogeneity[J].J Clin Oncol,2011,29(15):1937-1938.
[11]Greenberg PL,Stone RM,Al-Kali A,et al.Myelodysplastic Syndromes,Version 2.2017,NCCN Clinical Practice Guidelines in Oncology[J].J Natl Compr Canc Netw,2017,15(1):60-87.
[12]李璘,刘旭平,聂玲,等.原发性骨髓增生异常综合征染色体核型异常特征及其预后意义的研究[J].中华血液学杂志,2009,30(4):217-222.
[13]Muller PA,Vousden KH.Mutant p53 in cancer:new functions and therapeutic opportunities[J].Cancer Cell,2014,25(3):304-317.
[14]Leroy B,Anderson M,Soussi T.TP53 mutations in human cancer:database reassessment and prospects for the next decade[J].Hum Mutat,2014,35(6):672-688.
[15]Xu-Monette ZY,Medeiros LJ,Li Y,et al.Dysfunction of the TP53 tumor suppressor gene in lymphoid malignancies[J].Blood,2012,119(16):3668-3683.