Effect Of Serum Lipid Levels And Nutritional Status On Survival Time And Chemotherapy Efficacy In Patients With Multiple Myeloma

Objective To analyze the effects of serum lipid levels and nutritional status in patients with multiple myeloma（MM）on patient survival time and chemotherapy efficacy.Methods Patients who were hospitalized and diagnosed with MM at the First Hospital of Lanzhou University from January 2012 to October 2021 were selected.A total of 114 patients with primary diagnosis of MM and 71 patients with MM who had undergone 5 cycles of chemotherapy were screened by strict inclusion and exclusion criteria.The 114 patients with primary diagnosis of MM were grouped according to median HDL-c,PNI,COUNT score,IGH rearrangement,positive/negative grouping for D13S318 gene deletion for survival analysis;risk factors and protective factors for MM were analyzed using COX regression;independent variables in multifactorial COX regression were used as predictors,and prediction models were constructed using R language,and model differentiation,calibration,and The clinical utility of the model was validated and then plotted against the column line graph.The prognostic factors of MM were analyzed using binary logistic regression,and the differences in the levels of Alb,lipid,PNI and CONUT scores before and after chemotherapy were compared in 71 MM patients who had undergone 5 cycles of chemotherapy.Results1.Prognostic analysis of survival time in patients with primary diagnosis of MM suggested that the median survival time was longer in HDL-c ≥ 0.83 mmol/L,PNI ≥ 42.18,CONUT < 6,IGH normal group,and D13S319 normal group（all P< 0.05）.2.Univariate COX regression analysis of primary MM patients suggested that ISS stage,IGH rearrangement,D13S319 gene deletion,and CONUT score were risk factors for survival time in MM patients（all P < 0.05）,and Hb,HDL-c and PNI were protective factors for survival time in MM patients（all P < 0.05）.Multi-factor COX regression suggested that Hb and HDL-c were protective factors for survival time in MM patients（all P < 0.05）,and TC and IGH rearrangement were risk factors for survival time in MM patients（all P < 0.05）.3.The independent variables in the multifactorial COX regression were used as predictors,and the prediction models were constructed using R language,and the column line plots were plotted after validation of model discrimination,calibration,and clinical utility.4.After chemotherapy,the levels of TC,TG,HDL-c,LDL-c and PNI in MM patients were increased compared with those before chemotherapy（ALL P < 0.05）,while CONUT score was decreased（P < 0.05）.5.Patients in the PR group had higher CONUT score,Age level,IGH rearrangement rate,RB1 deletion rate and D13S319 gene deletion rate than those in the CR group（p < 0.05）;Alb,HDL-c and PNI levels in the PR group were lower than those in the CR group（all p < 0.05）.6.Binary logistic regression analysis showed that age,CONUT score,IGH rearrangement and RB1 gene deletion were negatively correlated with the likelihood of prognosis of CR after chemotherapy in MM patients（all p < 0.05）,and Alb,HDL-c and PNI were positively correlated with the likelihood of prognosis of CR after chemotherapy in MM patients（all p < 0.05）,relative to ISS stage I patients The likelihood of CR after chemotherapy was not statistically different in stage II patients compared to stage I patients,and the likelihood of CR after chemotherapy was lower in ISS stage III patients compared to stage I patients（OR=0.231,95CI%（0.06-0.888）,p<0.05）,and multifactorial analysis suggested that after correcting for ISS stage,Alb was positively associated with the likelihood of CR after chemotherapy in MM patients(OR =1.096,95CI%（1.014-1.184,p=0.02）;PNI was positively associated with the likelihood of prognosis of CR in MM patients with chemotherapy(OR=1.065,95CI%（1.001-1.132,p=0.045）;CONUT score was negatively associated with the likelihood of prognosis of CR in MM patients with chemotherapy（OR=0.783,95CI%（0.620-0.988）,p=0.04）.7.After covariate-corrected initial Alb,TC,TG,HDL-c,LDL-c PNI and CONUT score levels,corrected difference Alb,corrected difference TC,corrected difference TG,corrected difference HDL-c,corrected difference LDL-c,corrected difference PNI and corrected difference CONUT scores were compared between the PR and CR groups after chemotherapy.The results showed that corrected difference TC（1.91±0.20）,corrected difference HDL-c（0.373±0.045）and corrected difference LDL-c（1.612±0.15）and difference Alb（6.10±0.96）were higher in the CR group than in the PR group（1.12±0.21,p<0.05;0.175±0.047,p<0.05.0.863±0.157,p<0.05;2.56±1.0,p<0.05）.Conclusion1.Survival of MM patients was relatively longer when HDL-c ≥ 0.83mmol/L,PNI ≥ 42.18,CONUT score < 6,no IGH rearrangement,and D13S319 gene deletion.2.ISS stage,IGH rearrangement,D13S319 gene deletion,and CONUT score were risk factors for survival time of MM patients,and Hb,HDL-c,and PNI were protective factors for survival time of MM patients.After removing the confounding factors,Hb and HDL-c were protective factors for survival time in MM patients,and TC and IGH rearrangement were independent risk factors for survival time in MM patients.3.After chemotherapy,the levels of TC,TG,HDL-C,LDL-C and PNI in MM patients were increased compared with those before chemotherapy（ALL P < 0.05）,while CONUT score was decreased（P < 0.05）.the rates of Age,COUNT score,IGH rearrangement,RB1 deletion and D13S319 deletion were higher in the PR group than in the CR group;the levels of Alb,HDL-c and PNI were lower in the PR group than in the CR group.The rise of TC,HDL-c,LDL-c and Alb was higher in the CR group than in the PR group before and after chemotherapy.4.Patients with younger age,ISS stage I or II,increased Alb,HDL-c,PNI levels and decreased COUNT score after chemotherapy,without IGH rearrangement and D13S319 gene deletion had better chemotherapy effect and were more likely to achieve CR.