运用Cox模型和Sokal,Hasford积分系统对慢性髓细胞白血病患者的预后分析

Prognostic Analysis of Chronic Myeloid Leukemia with Cox Model and the Sokal, Hasford Score

本研究分析影响慢性髓细胞白血病(CML)患者预后的危险因素。采用回顾性研究分析204例CML患者的临床及实验室检查资料,用Kaplan-Meier法绘制生存曲线,用Logrank检验比较生存率,运用Cox回归模型进行单因素及多因素分析,并分别计算Sokal,Hasford积分。结果表明204例患者中位生存时间为50(32-65)月,5年生存率32.3%(95%CI,23.7%-42.6%)。干扰素组与羟基脲组的中位生存时间分别为56(41-67)月和41(19-56)月,5年生存率分别为45.4%(95%CI,37.5%-54.2%)和26.8%(95%CI,21.6%-33.3%)(P<0·001)。经Cox回归分析,Ph染色体阴性、乳酸脱氢酶含量增高、外周血嗜碱性粒细胞≥10%、出现有核红细胞、骨髓原粒细胞≥4%、骨髓原始+早幼粒细胞≥10%和红细胞压积降低是CML预后不良的危险因素,而治疗方法也是影响CML预后的重要因素。羟基脲组经Sokal积分检验,高危组占72.9%,中危组占21.5%,而低危组占5·6%,中位生存时间分别为34(23-49)月、43(32-58)月、50(38-62)月;干扰素组经Hasford积分检验,高危组占17.6%,中危组占25.1%,低危组占57.3%,中位生存时间分别为44(33-57)月、56(45-70)月和66(52-76)月。结论Ph染色体、乳酸脱氢酶含量、红细胞压积、外周血嗜碱性粒细胞、出现有核红细胞、骨髓原始和早幼粒细胞以及治疗方法是影响CML预后的重要因素。以Sokal积分系统评价羟基脲组患者不能很好区分危险组,而Has-ford积分系统评价干扰素组患者,能够区分危险组。

This study was aimed to analyze the prognostic factors of the patients with chronic myeloid leukemia （CML）. Survival curve and survival rate of 204 patients with CML were estimated with Kaplan-Meier method and Logrank respeetively. Univariate and multivariate analysis of prognostic factors carried out by Cox＇s regression model. The Sokal and Hasford score were used to discriminate the relative risk of Hu and IFN group. The results showed that among the 204 patients,the median survival time was 50（32 -65 ） months, and 5 year survival rate was 32.3% （95% CI, 23.7 % -42.6% ）. The median survival times of IFN and Hu group were 56 （41 -67 ） and 41 （ 19 -56 ）months, and 5 year survival rates were 45.4% （95 % CI, 37.5 % -54.2% ）and 26.8% （95 % CI, 21.6% -33.3 % ） （P 〈 0.001 ） respectively. From the Cox stepwise regression model, Ph chromosome negative, high LDH, low Hct, percentage of peripheral blood basophils≥10%, marrow blasts ＋ promyelocytes ≥10% and presence of nucleated RBCs was associated with poor prognosis, and the treatment also played an important role in CML. According to the Sokal score, the high, intermediate and low risk rates of Hu group were 72.9% ,21.5% and 5.6%, the median survival time reached 34 （ 23 - 49 ） months,43 （32 - 58 ） and 50 （38 - 62） months respectively; while censored by the Hasford score, the high, interme- diate and low risk rates of IFN group were 17.6%, 25.1% and 57.3% respectively, the median survival time was 44 （33 -57）, 56（45-70） and 66 （52 -76）months respectively. It is concluded that Ph chromosome, concentration of LDH, percentage of Hct, peripheral blood basophils, marrow blasts, promyelocytes, presence of nucleated RBCs and treatment are the most important prognostic factors for CML. The Sokal score can not discriminate the relative risk of Hu group well, while the Hasford score can discriminate the relative risk of IFN group.