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Title: [Predictive Value of Pre-treatment Serum Uric Acid Level for Prognosis in Newly Diagnosed Patients with Multiple Myeloma].
Author: Xu SQ, Zhao P, Wang ZH, Deng H, Zhang L, Wei J, Zou XL.
Journal: Zhongguo Shi Yan Xue Ye Xue Za Zhi; 2021 Aug; 29(4):1216-1223. PubMed ID: 34362505.
Abstract:
OBJECTIVE: To evaluate the predictive value of pre-treatment serum uric acid (sUA) level for the prognosis of newly diagnosed multiple myeloma (NDMM) patients. METHODS: The NDMM patients admitted to our center from January 2014 to December 2018 were analyzed retrospectively, and 94 patients among them who were initially treated with bortezomib-based chemotherapy for at least 4 cycles were included in this study. Clinical characteristics, laboratory data and follow-up information were collected, and the predictive value of sUA on the overall survival (OS) of NDMM was evaluated by using receiver operating characteristic (ROC) curve based on the patient's pre-treatment sUA level and the survival status at the end of follow-up, and the correlation of the sUA level with patient's clinical, laboratory characteristics and overall survival (OS) was further analyzed. The univariate and multivariate Cox proportional-hazards model were used to identify the potential factors affecting OS. RESULTS: ROC analysis showed that the area under the curve for predicting OS in NDMM patients with sUA level was 0.702 (P<0.001), and the optimal cut-off value was 455.4 μmol/L. Compared to patients with low sUA (<455.4 μmol/L), patients with higher sUA (≥455.4 μmol/L) were more likely to have international staging system (ISS) stage III disease, beta2-microglobulin (β₂-MG) ≥5.5 mg/L, serum creatinine (sCr) ≥177 μmol/L, serum corrected calcium (cCa) ≥2.75 mmol/L, urea nitrogen (BUN) ≥1×upper limit of normal, and high-risk cytogenetic abnormality (all with P<0.001). At a median follow-up of 22.5 months, the OS of NDMM with lower sUA was significantly better than higher sUA (median OS: not reached vs 32 months, P=0.003). Univariate COX regression analysis identified that age ≥60 years old, ISS stage III, sUA ≥455.4 μmol/L, β₂-MG ≥5.5 mg/L, cCa ≥2.75 mmol/L were risk factors affecting OS. The multivariate COX regression analysis that only age ≥60 years old (HR=2.317, 95%CI: 1.015-5.288, P=0.045) and sUA ≥455.4 μmol/L (HR=2.785, 95%CI: 1.054-7.361, P=0.039) were independent risk factors affecting OS. CONCLUSION: Pre-treatment sUA level is a potential biomarker for the prognosis evaluation in NDMM patients, which deserves a further exploration and verification. 题目: 治疗前血尿酸水平在初诊多发性骨髓瘤患者预后判断中的价值. 目的: 研究初诊多发性骨髓瘤(NDMM)患者治疗前血尿酸（sUA）水平在其预后判断中的价值. 方法: 检索本中心2014年1月－2018年12月收治的NDMM患者资料，将初始治疗采用以硼替佐米为基础的化疗方案（≥4周期）且资料完整的94例患者纳入本研究。收集患者临床、实验室检查及随访资料，根据患者治疗前sUA水平及随访截止时的生存状态绘制受试者工作特征曲线，判断sUA对患者总体生存的预测价值，进一步分析sUA水平与患者的临床、实验室检查特征以及总体生存（OS）的相关性，采用单因素及多因素COX风险比例回归模型分析影响OS的因素. 结果: 受试者工作特征曲线分析显示，以sUA水平预测NDMM患者OS的曲线下面积为0.702（P<0.001），其最佳截断值为455.4 μmol/L；相对于低sUA患者（<455.4 μmol/L），高sUA（≥455.4 μmol/L）患者国际分期系统分期Ⅲ期、高β₂-微球蛋白（≥5.5 mg/L）、肾脏损害（血肌酐≥177 μmol/L）、高钙血症（≥2.75 mmol/L）、高尿素氮（≥1×正常参考值上限）、伴高危细胞遗传学异常的比例更高（P<0.001）。中位随访22.5个月，低sUA患者的OS明显长于高sUA患者（中位OS：未达到 vs 32个月，P=0.003）。单因素COX回归分析显示，年龄≥60岁、国际分期系统分期Ⅲ期、sUA≥455.4 μmol/L、β₂-微球蛋白≥5.5 mg/L、高钙血症≥2.75 mmol/L是影响患者OS的危险因素。多因素COX回归分析显示，仅年龄≥60岁（HR=2.317，95%CI：1.015-5.288，P=0.045）、sUA≥455.4 μmol/L（HR=2.785，95%CI：1.054-7.361，P=0.039）是影响NDMM患者OS的独立危险因素. 结论: 治疗前sUA水平在NDMM患者的预后评估中具有一定的意义，有必要进一步探索和验证.

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