背景:多发性骨髓瘤(MM)患者存在骨骼相关事件(SRE)的风险,如脊髓压迫,病理性骨折,骨手术,对骨骼的辐射。关于MM中的SRE的真实世界数据是有限的。
方法:我们进行了大量的,回顾性,使用韩国健康保险审查和评估服务(HIRA)数据库从2007年到2018年的全国队列研究。
结果:在12年的研究期间,我们确定了6,717例出现症状MM的患者。在中位随访35.1个月后(四分位数间距[IQR],20.8-58.2个月),这些患者中有43.6%经历了SRE,39.6%有四个或更多的SREs。五分之一的患者(20.0%)在随访的第一年内经历了病理性骨折。首次SRE的中位时间为9.6个月(IQR,1.2-25.8个月),之前有SRE的组中有3.0个月,没有之前有SRE的组中有19.8个月。随访期间,78.5%的患者接受双膦酸盐治疗。多因素logistic回归分析揭示了与SREs风险增加相关的几个因素,包括女性(赔率比[OR],1.44),50岁或以上(或,1.87),患有脑血管疾病(或,1.34),接受不含硼替佐米或来那度胺的一线化疗方案(OR,1.49),并且在先前使用SREs和双膦酸盐的组中(OR,5.63),与未使用SREs和未使用双膦酸盐的组相比。
结论:这项基于人群的研究首次报道了韩国MM患者中SRE的发生率和危险因素,这可以用来评估他们的骨骼健康。
BACKGROUND: Multiple myeloma (MM) patients are at risk of skeletal-related events (SREs) like spinal cord compression, pathologic fractures, bone surgery, and radiation to bone. Real-world data regarding SREs in MM are limited.
METHODS: We conducted a large, retrospective, nationwide cohort study using the Korean Health Insurance Review and Assessment Service (HIRA) database from 2007 to 2018.
RESULTS: Over a 12-year study period, we identified 6,717 patients who developed symptomatic MM. After a median follow-up of 35.1 months (interquartile range [IQR], 20.8-58.2 months), 43.6% of these patients experienced SREs, and 39.6% had four or more SREs. One in five patients (20.0%) experienced pathologic fractures within the first year of follow-up. The median time to first SRE was 9.6 months (IQR, 1.2-25.8 months), with 3.0 months in the group with prior SREs and 19.8 months in the group without prior SREs. During follow-up, 78.5% of patients received bisphosphonates. Multiple logistic regression analysis revealed several factors associated with an increased risk of SREs, including being female (odds ratio [OR], 1.44), aged 50 or older (OR, 1.87), having cerebrovascular disease (OR, 1.34), undergoing first-line chemotherapy regimens not containing bortezomib or lenalidomide (OR, 1.49), and being in the group with prior SREs and bisphosphonate use (OR, 5.63), compared to the group without prior SREs and without bisphosphonate use.
CONCLUSIONS: This population-based study is the first to report the incidence and risk factors of SREs in Korean MM patients, which can be used to assess their bone health.