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目的分析儿童急性淋巴细胞白血病(ALL)诱导治疗结束时外周血绝对淋巴细胞计数(ALC)与预后关系,并探讨其影响因素。方法收集2002年4月1日至2013年3月31日在中山大学附属第一医院儿科诊治的0~16岁初诊儿童ALL的临床资料,并随访治疗结果。分析诱导治疗结束时外周血ALC与危险度分级、年龄、5年无事件生存率(EFS)、累计复发率(CIR)和治疗相关死亡率(TRM)的关系。生存曲线和生存率用Kaplan-Meier法预测,生存曲线的比较采用log-rank检验,预后影响因素用多因素逐步Cox比例风险回归模型进行筛选。结果共348例儿童ALL纳入分析。低ALC组(≤0.62×109/L)和高ALC组(>0.62×109/L)的5年EFS分别为(61.6±5.6)%和(81.8±1.5)%,差异有统计学意义(P<0.05)。低ALC组和高ALC组的5年CIR分别为(28.0±5.6)%和(15.3±2.4)%,TRM分别为(12.8±3.8)%和(2.9±1.1)%,差异有统计学意义(P<0.05)。只在≤6岁的儿童ALL,低ALC组的预后较高ALC组差[(82.9±3.2)%vs.(45.7±8.6)%,差异有统计学意义(P<0.05)。多因素回归分析显示,低ALC是影响预后的独立因素之一,危险比1.95,95%置信区间(1.22,3.11)。结论诱导治疗结束时外周血ALC低是≤6岁儿童ALL预后不良的独立因素,治疗相关死亡率和累积复发率相对较高。
Objective To analyze the relationship between peripheral blood absolute lymphocyte count (ALC) and prognosis at the end of induction therapy in children with acute lymphoblastic leukemia (ALL) and to explore its influencing factors. Methods The clinical data of pediatric ALL patients aged 0-16 years old with pediatric diagnosis and treatment at the First Affiliated Hospital of Sun Yat-sen University from April 1, 2002 to March 31, 2013 were collected and followed up. The association of ALC with risk grade, age, 5-year event-free survival (EFS), cumulative relapse rate (CIR) and treatment-related mortality (TRM) at the end of induction therapy was analyzed. Survival curves and survival rates were predicted by Kaplan-Meier method, log-rank test was used to compare survival curves, and prognostic factors were screened by multi-factorial Cox proportional hazards regression model. Results A total of 348 children with ALL were included in the analysis. The 5-year EFS of low ALC group (≤0.62 × 109 / L) and high ALC group (> 0.62 × 109 / L) were (61.6 ± 5.6)% and (81.8 ± 1.5)%, respectively <0.05). The 5-year CIR of low ALC group and high ALC group were (28.0 ± 5.6)% and (15.3 ± 2.4)% respectively, and TRM were (12.8 ± 3.8)% and (2.9 ± 1.1)%, respectively P <0.05). The difference was statistically significant (P <0.05) only in patients with ALL ≤6 years, with a higher prognosis in the ALC group than in the ALC group (82.9 ± 3.2) vs (45.7 ± 8.6)%. Multivariate regression analysis showed that low ALC was one of the independent factors affecting the prognosis, hazard ratio 1.95, 95% confidence interval (1.22, 3.11). Conclusions ALC low in peripheral blood at the end of induction therapy is an independent predictor of poor prognosis in children ≤6 years old. The treatment-related mortality and cumulative relapse rate are relatively high.