Validation of the Molecular International Prognostic Scoring System (IPSS-M) for myelodysplastic neoplasms (MDS) and comparison with the revised International Prognostic Scoring System (IPSS-R) in Chinese Population: A Multicenter Retrospective Study.

Abstract

Objectives The Revised international prognostic scoring system (IPSS-R) is now commonly being used clinically to guide the treatment of myelodysplastic neoplasms (MDS). Recently, the Molecular International Prognostic Scoring System (IPSS-M)was proposed. In this study, we have validated the potential predictive value of the comparative IPSS-M in Chinese MDS patients. Design Retrospective multicenter observational study. Setting and participants 113 MDS patients(April 2019 - June 2022) from 10 distinct centers in Jiangnan region of China, grouped by IPSS-R and IPSS-M was obtained and the scoring criteria were retrospectively analyzed to compare the prognostic assessment efficacy of the different prognostic assessment systems. Main outcome measures The prognostic indicators of MDS patients are main outcome measures. Results 72 (63.7%) patients were reclassified after regrouping from IPSS-R to IPSS-M, and 52 of them were transferred to a higher risk group, with a higher percentage of patients aged ≥ 60 years in the higher risk group. Survival analysis confirmed that overall survival(OS) was variable in the different risk strata, with shorter survival time in the higher risk group and lower OS in the older(≥ 60 years) than in the younger group; whereas in univariate and multifactorial analysis, age ≥ 60 years, percentage of bone marrow blasts, chromosomal classification of IPSS-R, TP53, RUNX1, DNMT3A, NRAS, CBL, GNAS, and FLT3_ITD gene mutation were associated with OS. Leukemia-free survival(LFS)analysis revealed that higher IPSS-R and IPSS-M risk stratification was linked with shorter LFS time. Receiver operating characteristic (ROC) curves were drawn according to OS displaying AUC = 0.629 for IPSS-R and AUC = 0.705 for IPSS-M; AUC = 0.635 for IPSS-M younger group and AUC = 0.691 for older group. Conclusions Our study confirmed that the IPSS-M prognostic scoring system could be applicable to Chinese patients and that IPSS-M was significantly better than IPSS-R for the prognostic assessment of MDS patients. Moreover, IPSS-M appeared to have better predictive validity in older patients compared to younger patients.