老年急性髓系白血病的非遗传学预后影响因素分析

Prognostic Exploration of Non-Genetic Factors in Elderly Patients with Acute Myeloid Leukemia

目的研究非遗传学因素对老年急性髓系白血病(acute myeloid leukemia,AML)预后的影响。方法回顾性分析医院收治的168例AML患者的临床资料,患者年龄均不小于60岁,且为非M3型AML。根据是否接受化学治疗(简称化疗)分为诱导缓解治疗组(IC组)与姑息治疗组(NIC组)。其中IC组患者接受诱导缓解治疗,NIC组患者接受姑息治疗。对比两组患者的治疗效果,对可能影响预后的非遗传学因素分别进行单因素分析及多因素预后分析。结果 IC组中,采用IA方案、DA方案及CAG方案化疗患者完全缓解率及中位生存期比较,差异无显著性(P>0.05);IC组患者中位生存期及早期死亡率与NIC组患者比较有显著性差异(P<0.01);单因素分析显示,患者的年龄、病因、入院时临床状况、合并症、白细胞(WBC)水平、血小板(PLT)水平、治疗方法及治疗效果与治疗后生存时间有关(P<0.05);在COX比例风险模型中,继发性AML、入院时WBC≥100×109/L、体力状况(PS)评分为3~4分、合并症指数(CCI)评分≥2分、姑息治疗及未达到缓解,是影响老年AML患者预后的独立危险因素。结论相比姑息治疗,化疗可延长老年AML患者生存期限及降低早期死亡率;年龄不是决定是否化疗的主要因素,而应根据患者的病因、临床状况等多种因素评估来选择合适方案进行分层治疗。

Objective To explore the non-genetic factors which affected the prognosis in elderly patients who had acute myeloid leukemia（AML）. Methods Various clinical parameters were analyzed retrospectively in 168 cases with AML. All patients＇ age were more than 60 years old and M3 subtype was excluded. The patients were divided into the IC group and NIC group according to whether accepted chemotherapy. The IC group was treated by induction therapy while the NIC group was treated by palliative treatment. The clinical efficacy between two groups was compared, and the single factors analysis and multiple factors analysis were applied for all the non- genetic factors which were likely to affect the prognosis. Results In the IC group,there was no significant difference of CR rate or median survival time among the patients treated with IA,DA or CAG chemotherapy regimens（P 〉 0.05）.There were significant dif- ferences in the median survival time and early mortality between the IC group and NIC group（P 〈 0.01）. Single factor analysis showed that patient survival time which was counted after treatment were connected with these factors such as age,pathogenesis,clinical status, complication, WBC, Plt, therapeutic method and therapeutic method（P 〈 0. 05）. Cox proportional hazard model showed these factors,including the secondary leukemia,WBC ≥ 100 × 10^9/L on admission,PS score of 3-4 points CCI scores ≥ 2, palliative treatment and non-received complete remission, were the independent risk factors affecting the prognosis in elderly patients with AML. Conclusion Compared with the palliative treatment,induction therapy shows the advantage of improving survival time and reducing early mortality for elderly patients with AML. Age should not be taken into account when choosing chemotherapy. It should be evaluated the etiology,clinical situation and other factors firstly and then apply layered treatment.