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目的:探讨适合中国急性髓系白血病(AML)患者的预后分层标准。方法:收集634例AML患者的临床资料,临床特征及实验室检查,采用U检验及COX回归分析,生存分析应用Kaplan-Meier法,Log-rank检验对美国国立综合癌症网络(NCCN)国际临床实践指南(2015)、美国西南肿瘤组(SWOG)指南、英国研究理事会(MRC)指南对其预后进行回顾性分析。结果:1根据NCCN指南分为3组:预后良好组、预后中等组和预后不良组,中位生存期分别为36.0(95%CI29.0~42.9)个月、10.1(95%CI8.4~12.0)个月,3.9(95%CI 1.8~6.0)个月,总生存期差异有统计学意义(P<0.01)。根据SWOG指南无法将预后未知组与预后不良组患者进行明确划分,二者差异无统计学意义(P=0.617)。MRC指南将11q、7q-异常归入了预后中等组,3组中位生存期分别为36.5(95%CI294.3~48.7)个月、8.9(95%CI7.2~10.9)个月,5.8(95%CI 2.9~7.8)个月,差异有统计学意义(P<0.05),但预后中等组中位生存期下降。2年龄≥60岁患者,按照NCCN指南划分3组预后,总生存期差异无统计学意义(P=0.079),且含染色体单体核型和复杂核型患者发病率较<60岁患者的发病率高(10.1%∶7.1%,10.1%∶6.2%,P<0.05)。结论:NCCN指南可对我国年龄<60岁AML患者进行更为准确的危险度分组和预后评估,但对我国年龄>60岁AML患者预后划分准确性欠佳,需进一步探索。
Objective: To investigate the prognostic stratification criteria for Chinese patients with acute myeloid leukemia (AML). Methods: The clinical data, clinical features and laboratory tests of 634 patients with AML were collected and analyzed by U-test and COX regression analysis. Survival analysis was performed using Kaplan-Meier method and Log-rank test in international clinical practice of the National Comprehensive Cancer Network (NCCN) A retrospective analysis of its prognosis was conducted in the guidelines (2015), the Southwest Oncology Group (SWOG) guidelines and the British Research Council (MRC) guidelines. According to the guidelines of NCCN, the patients were divided into 3 groups: the good prognosis group, the moderate prognosis group and the poor prognosis group, the median survival time was 36.0 (95% CI29.0-42.9) months, 10.1 (95% CI 8.4 ~ 12.0) months, 3.9 (95% CI 1.8 ~ 6.0) months, the difference was statistically significant (P <0.01). According to the SWOG guidelines, it is impossible to classify patients with unknown prognosis and patients with poor prognosis. There is no significant difference between the two groups (P = 0.617). The MRC guidelines classified 11q and 7q-abnormalities as intermediate-prognostic groups with median survival of 36.5 (95% CI, 94.3-48.7) months, 8.9 (95% CI 7.2-10.9) months, 5.8 (95% CI 2.9 ~ 7.8) months, the difference was statistically significant (P <0.05), but the prognosis of the median group decreased median survival. There were no significant differences in the overall survival between the two groups (P = 0.079). The incidence of haplotypes and complex karyotypes in patients with age≥60 years was lower than that in patients <60 years High rates (10.1%: 7.1%, 10.1%: 6.2%, P <0.05). CONCLUSION: The NCCN guidelines can be used to perform more accurate risk stratification and prognosis assessment in Chinese AML patients aged <60 years. However, the accuracy of the prognosis classification of AML patients aged> 60 years in China is poor and need further exploration.