Objective: To discuss the impact of comorbidities on the outcomes of patients with MDS.
Methods: The clinical characteristics of 676 MDS patients with detailed comorbidities evaluations was analyzed retrospectively.
Results: There were 395/676 cases (58.4%) with comorbidities (group 1), 281/676 cases (41.6%) without (group 2). Significant differences were seen in the distribution of age (≥ 60 y), bone marrow blasts, abnormal karyotype, WHO 2008 subtypes and IPSS-R risk cohorts (P<0.05) between the two groups. While gender, HGB concentrations, WBC levels, platelet levels and serum ferritin were not significantly different (P>0.05). Independent prognostic significance of comorbidities was seen in both uni-variate and multi-variate analyses (P<0.001). According to MDS-specific comorbidity index (MDS-CI), the median survival were 32(1-153) months, 19(2-85) months and 13(1-37) months in the low-risk, intermediate-risk and high-risk cohorts respectively, while 96(1-166) months in cohorts without any comorbidities, of which significant differences were seen (P<0.001). The MDS-CI allowed further stratification in the IPSS-R low-risk, intermediate-risk and high-risk cohorts (P<0.001).
Conclusion: Comorbidities provides prognostic stratification independently of IPSS-R for MDS patients.
目的: 探讨合并疾病对骨髓增生异常综合征（MDS）患者预后的影响。
方法: 回顾性分析676例连续入组有详细合并疾病评估的MDS患者临床资料并进行统计学分析。
结果: 676例患者中395例（58.4%）伴有合并疾病（合并疾病组），281例（41.6%）不伴合并疾病（无合并疾病组）。两组患者≥60岁比例（32.4%对18.5%）、骨髓原始细胞比例中位数[0.035（0~0.190）对0.025（0~0.190）]、染色体核型异常比例（37.5%对35.9%）、分型诊断构成比和修正版国际预后积分系统（IPSS-R）分组比较，差异均有统计学意义（P值均<0.05）。多因素COX分析证实合并疾病为影响患者总生存（OS）的独立预后因素（HR=3.051，95%CI 2.018~4.612，P<0.001）。按MDS特异性合并疾病指数（MDS-CI）评分模型对伴有合并疾病的MDS患者进行危险度分组，低、中、高危患者中位OS时间分别为32（1~153）、19（2~85）、13（1~37）个月，而不伴有合并疾病的患者中位OS时间为96（1~166）个月，差异有统计学意义（P<0.001）。IPSS-R低危、中危及高危组患者根据MDS-CI模型进行再分组，各组患者OS时间比较差异均有统计学意义（P值均<0.01）。
结论: 合并疾病是MDS患者独立于IPSS-R之外的预后影响因素。