Abstract

The purpose of this study was to investigate the risk factors in prognosis of patients with myelodysplastic syndrome (MDS) to emphatically study the clinical significance of different scoring systems such as Bournemouth-, Spanish-, Düsseldorf-, Lille, and the International prognostic scoring systems (IPSS), French-American-British (FAB) and World Health Organization (WHO) classifications as well as abnormal clone of chromosome, bone marrow and hematological indicators in evaluating prognosis of MDS patients, and to identify the independent factor related to prognosis. All clinical data of 69 consecutive patients diagnosed as primary MDS over a period of 5 years were collected and stored by Epi Data 3.0, 63 patients out of which were followed up. SPSS 13.0 software was applied to deal with all data. The statistical methods included life table, Kaplan-Meier, Log-rank test and Cox regression. The results indicated that the median age of 63 patients was 38 years. 26 out of 63 patients had karyotype aberration (41.27%). Median OS was 30.63 months, and 33 patients (52.38%) died. All five prognostic scoring systems could successfully discriminate risk groups as regards overall survival. IPSS, Lille and Spanish prognostic scoring system were more effective (p<0.0001). Multivariate Cox regression analysis indicated that IPSS (p<0.0001) and Lille chromosome classifications (p<0.0001) were most important factors for OS followed by bone marrow blasts (p=0.00062), Spanish prognostic scoring system (p=0.00064) and Lille prognostic system (p=0.008). The WHO classifications also successfully discriminated between risk groups (p<0.0001). The new WHO subgroups [refractory cytopenia with multilineage dysplasia (RCMD), with or without ringed sideroblasts] showed a significantly different prognosis (p=0.003) for OS, in comparison to the subgroups having erythroid dysplasia only (RA/RARS) and 5q-syndrome. All patients were reclassified to FAB classification, and the low risk group (RA/RAS) and high risk group (RAEB) also had significant difference (p=0.00012) as regards OS. It is concluded that the major independent prognostic variables for OS are percentage of bone marrow blasts and karyotype aberration. The use of WHO classification have more significance for improving predictive value than that of the FAB classification, and the IPSS can be used for clinical decision-making in patients with cytogenetic results. In the hospitals which cannot carry out the cytogenetic examination, Spanish prognostic system can be applied to the patients without cytogenetic results.