| Objective:To explore the value of immunophenotype by multicolor flow cytometry for diagnosis and prognostic evaluation of hematologic malignancies with malignant serous effusion,in order to provide an important method for the early diagnosis and evaluate the prognosis of these patients.Methods:A total of 48 patients confirmed with hematologic malignancies with serous effusion from February 2017 to February 2021 in the Research Center were collected.All patients underwent FCM examination for serosal effusion.The clinical data and laboratory examination results of the patients were retrospectively analyzed.The detection rate of malignant serosal effusion by FCM was compared with that by positron emission tomography/computed tomography,and the correlation between the proportion of abnormal immunotyping cells in FCM and the conventional cell classification and biochemical indices of the effusion was analyzed.At the same time,the clinical characteristics of patients with positive and negative FCM tests were analyzed and compared,and Kaplan-Meier method was used to analyze the survival of patients in these two groups.Univariate and multivariate analyses were used to analyze the prognosis of such patients by Cox proportional hazard regression model.Results:First,clinical features:Among the 48 patients,there were 32 males and 16 females,the sex ratio was 2:1,and the median age was 60 years old(range:30-85 years).The hematologic malignancies types in 48 patients were lymphoma in twenty-four,multiple myeloma in eleven,leukemia in seven,myelodysplastic syndrome in two,lymphoproliferative disease in two,Waldenstrom macroglobulinemia in one,and the last one was primary amyloidosis.Second,comparison of the detection rate of malignant serous effusion:There were 24 cases(50%)diagnosed with malignant serous effusion by flow cytometry,while only 4 were positive for exfoliative cytology.The diagnostic positive rate of FCM in detecting hematologic malignancies patients with malignant serous effusion was higher than that of exfoliative cytology,the difference was statistically significant(P<0.001).Among the 24 patients who underwent PET/CT examination at the same time,13 patients were positive for FCM and 8 patients were positive for PET/CT.The difference between FCM and PET/CT was no statistically significant(P=0.125),but they had good consistency,Kappa=0.432.Third,correlation analysis of aberrant immunophenotype cells and laboratory indicators:There was no correlation between the ratio of aberrant immunophenotype cells and classification of cells and biochemical indicators in SE in these 48 patients(P>0.05).But in 24 patients with malignant effusion diagnosed by flow cytometry,the ratio of aberrant immunophenotype cells diagnosed by multicolor flow cytometry was positively correlated with classification of cells and biochemical indicators in SE(P<0.05).Fourth,survival analysis:The median follow-up was 19.5 months(range:1-47 months),there were 26(54%)patients died at the end of the follow-up.The overall survival from the occurrence of effusion to the end of the follow-up of patients with malignant effusion diagnosed by flow cytometry were significantly longer than those of patients without malignant serous cavity effusion(P=0.03 5),but the difference of the overall survival from the confirm of the diagnosis to the end of the follow-up between two groups was no statistically significant(P=0.098).Meanwhile,regardless of the FCM results,the OS from the occurrence of effusion to the end of the follow-up of patients with effusion disappeared was significantly longer than that of patients without effusion disappeared(P<0.05).Fifth,analysis of prognostic factors:Univariate analysis revealed that:whether the effusion disappears(P=0.015)、the results of FCM(P=0.048)、platelet count(P=0.006)、creatinine levels(P=0.020).But the results of FCM had no effect on the overall survival from the occurrence of effusion to the end of the follow-up of patients.Cox regression analysis showed that whether the effusion disappears was highly predictive of survival whenever follow-up(P<0.05).Conclusion:The diagnostic positive rate of FCM Immunophenotyping in detecting hematologic malignancies patients with serous cavity invaded was higher than that of CM and PET/CT,FCM can be used for cell identification and analysis more quickly,accurately and objectively,and can be used as a necessary joint examination item in routine serosal effusion examination.Flow immunotyping only affected the survival time from serosal effusion to the end of follow-up,but had no significant effect on the overall survival time from diagnosis to the end of follow-up.Whether the effusion disappears,FCM results,platelet count,and creatinine level are the risk factors affecting patients from the occurrence of effusion to the end of the follow-up.Whether the effusion disappears is an independent risk factor affecting the prognosis of such patients,which can be used as the main therapeutic target. |
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