美国西南肿瘤组／东部肿瘤协作组染色体核型分组法与急性髓系白血病预后关系的研究

Study on the relationship between the grouping criterion of SWOG/ECOG and the prognosis of acute myeloid leukemia

目的探讨急性髓系白血病（AML）患者染色体核型异常发生率、分布以及美国西南肿瘤组与东部肿瘤协作组（SWOG／ECOG）染色体核型分组法在预后评价中的意义。方法常规培养83例AML患者的骨髓细胞，吉姆萨显带分析染色体核型。根据SWOG／ECOG核型分类方法对核型进行分组，采用Kaplan—Meier方法观察不同危险组的生存情况。结果83例AML患者中56例细胞核型检出异常（67．47％）。AML伴t（15；17）易位与伴t（8；21）易位在异常核型患者中所占比例为53．57％（30／56），其余核型分布较分散。随访的74例患者中，42例死亡。预后良好、中等、不良3组生存期比较差异具有统计学意义（P〈0．001）。预后良好组完全缓解率高于预后中等及不良组（P〈0．05），预后中等组与不良组差异无统计学意义（P〉0．05）。结论细胞遗传学改变是影响白血病预后的主要因素之一，SWOG／ECOG核型分组能比较客观地反映AML的预后。

Objective To investigate the incidence and distribution of aberrational karyotype in acute myeloid leukemia （AML）, and study the significance of the grouping by Southwest Oncology Group/Eastern Cooperative Oncology Group （SWOG/ECOG） in the prognosis of AML. Methods The chromosome was prepared with brief culture of bone marrow, and the karyotype was analysed by G banding technique. All the patients were grouped according to the criterion of SWOG/ECOG, and the survival function of different groups was observed by the Kaplan-Meier method. Results 56 （67.47 %） out of 83 patients had clonal chromosome aberrations. Among those 56 patients, AML with translocation （15;17） and with translocation （8;21） presented in 30 patients（53.57 %）, and the other kinds of aberrational karyotypes shared the left proportion. Among the 74 followed-up patients, 42 patients were dead. Among three groups with favorable, intermediate and adverse prognosis respectively, there is a significant difference （P 〈0.001）. The complete remission rate of favorable group is higher than that of both intermediate and adverse （P 〈0.05）. There is no difference between intermediate and adverse groups（P 〉0.05）. Conclusion Cytogenetie aberration is one of the important factors affecting the effect on prognosis, The criterion of SWOG/ECOG can predict prognosis objectively.