单体核型在急性髓系白血病中的预后意义

Prognostic significance of monosomal karyotype in acute myeloid leukemia

目的探讨单体核型（MK）在急性髓系白血病（AML）中的预后意义。方法回顾性分析498例AML患者的临床资料并进行统计学分析。结果498例AML患者中233例（46．8％）为异常核型，MK42例，占全部患者的8．4％及异常核型的18．O％，最常见的为-7、-17。复杂核型（CK）70例，占全部患者的14．1％及异常核型的30．0％。与不伴有MK的AML患者比较，伴有MK者发病年龄较高（中位年龄62．5岁对52岁，P=0．003），外周血血红蛋白浓度较低（62．5g／L对77g/L，P=0．009），白细胞计数较低（7．0×10^9／L对11．7×10^9／L，P=0．008）。MK中常见的不良预后核型是复杂核型、-7、-5、7q-、5q-。单因素分析发现伴有MK的患者预后明显差于不伴有者（中位生存期分别为7．3和26．3个月，P〈0．001）。伴有CK的患者预后亦差于不伴有者（中位生存期分别为14．8和26．3个月，P〈0．001）。在伴有CK患者中，伴有MK的患者预后差于不伴有者（中位生存期分别为7．4和19．2个月，P=0．007）。COX回归风险模型分析显示MK是AML患者独立于NCCN预后分组和CK的预后因素（HR=2．610，95％CI1．632-4．175，P〈0．001）。结论MK是AML患者独立的不良预后因素。

Objective To explore the prognostic significance of monosomal karyotype （MK） in patients with acute myeloid leukemia （AML）. Methods The clinical data of 498 AML patients were analyzed retrospectively. Results Of the 498 patients, 233 （46.8%） cases had an abnormal karyotype. 42 patients fulfilled the criteria for MK, which were 8.4% of all cases and 18.0% of patients with abnormal karyotype, respectively. The most frequent autosomal monosomies were- 7 and- 17. 70 patients had complex karyotype （CK）, in all patients and patients with abnormal karyotype accounted for 14.1% and 30.0%, respectively. Patients with MK were associated with significantly older （median age 62.5 vs 52 years, P=0.003）, and lower HGB concentrations （62.5 vs 77 g/L, P=0.009） and lower WBC counts （7.0 ×10^9/L vs 11.7 ×10^9/L, P=0.008）. Among MK cases, the most frequent chromosome abnormalities were complex karyotype, -7, -5, 7q-, and 5q-. In univariate analysis, MK patients had worse survival than those without MK （7.3 months vs 26.3 months, P〈0.001）. CK patients also had poorer outcomes than patients without CK （14.8 months vs 26.3 months, P〈0.001）. In CK patients, survival was worse in MK patients than patients without MK （7.4 months vs 19.2 months, P=0.007）. By COX analysis, MK was an independent prognostic factor, beyond NCCN criteria and CK IHR=2.610 （1.632-4.175）, P〈0.001]. Conclusion MK was an independent adverse prognostic factor in AML patients.