Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic premalignant disorder. The current standard of care is not to screen for MGUS, so it is often incidentally diagnosed in the clinic. It is unknown whether the outcomes of screened vs clinically detected MGUS differ. We compared the progression risk between screened vs clinical MGUS cohorts and assessed whether the MGUS detection method affected risk prediction of established clinical factors (score). We included 379 screened MGUS cases from the Olmsted County population-based study and 1384 patients with MGUS diagnosed during routine clinical evaluation at Mayo Clinic. Median follow-up time for the screened vs clinical cohort was 26.6 and 40.1 years, respectively. Accounting for death as a competing risk, the cumulative incidence of progression at 25 years was similar in the screened (11.1% [95% confidence interval [CI], 8.3-14.8]) vs clinical (10.1% [95% CI, 8.6-11.8]) MGUS cohorts, even when stratified by sex, age, or the baseline MGUS risk score. Overall, 0.9 (95% CI, 0.6-1.2) of patients with screened MGUS vs 1.0 (95% CI, 0.9-1.2) of those with clinically detected MGUS experienced disease progression for every 100 person-years of follow-up. MGUS detection method did not modify the association between MGUS risk score and progression risk (pinteraction = 0.217) and did not add to known risk factors for progression (likelihood ratio test; P = .839). Here, we show that progression risk among patients with screened vs clinically detected heavy-chain MGUS was similar. Future studies are needed to assess whether tailored follow-up of patients with screened MGUS affects clinical outcomes.

中文翻译：

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通过检测方法比较意义未明的单克隆丙种球蛋白病的进展风险


意义未明的单克隆丙种球蛋白病 （MGUS） 是一种无症状的癌前病变。目前的护理标准不是筛查 MGUS，因此经常在诊所偶然诊断出来。目前尚不清楚筛查与临床检测的 MGUS 的结局是否不同。我们比较了筛选与临床 MGUS 队列之间的进展风险，并评估了 MGUS 检测方法是否影响已建立临床因素 （评分） 的风险预测。我们纳入了来自奥姆斯特德县人群研究的 379 例筛查的 MGUS 病例和 1384 例在妙佑医疗国际常规临床评估中诊断的 MGUS 患者。筛选队列与临床队列的中位随访时间分别为 26.6 年和 40.1 年。考虑到死亡是一种竞争风险，筛选 （11.1% [95% 置信区间 [CI]，8.3-14.8%） 与临床 （10.1% [95% CI，8.6-11.8]） MGUS 队列在 25 年时的累积进展发生率相似，即使按性别、年龄或基线 MGUS 风险评分分层。总体而言，每 100 人年随访 0.9 例 （95% CI，0.6-1.2） 例筛查 MGUS 患者，而 1.0 例 （95% CI，0.9-1.2） 例临床检测的 MGUS 患者出现疾病进展。MGUS 检测方法未改变 MGUS 风险评分与进展风险之间的关联 （pinteraction = 0.217），也没有增加已知的进展危险因素 （似然比检验;P = .839）。在这里，我们表明筛查与临床检测到的重链 MGUS 患者的进展风险相似。需要进一步的研究来评估对筛查的 MGUS 患者进行量身定制的随访是否会影响临床结局。