不同评分系统评估慢性粒细胞白血病患者预后的比较

Comparison of four scoring systems to assess the prognosis of patients with chronic myeloid leukemia

目的:比较现有预后评分系统在新诊断的慢性粒细胞白血病(chronic myeloid leukemia,CML)患者中预测疗效及预后的有效性。识别治疗反应率和生存率明显较低的CML患者,有利于进行早期干预。进一步评估ELTS评分作为预测“CML相关性死亡发生率”这一新指标的能力。方法:回顾性分析2010年1月至2019年12月连云港市第一人民医院确诊并接受一线伊马替尼治疗的172例慢性粒细胞白血病慢性期(chronic myeloid leukemia-chronic phase,CML-CP)患者,采用Sokal、Hasford、EUTOS及ELTS评分,将患者分为各个风险组并比较各评分系统对CML患者总生存期(overall survival,OS)、无进展生存期(progression free survival,PFS)、主要分子学反应(major molecular response,MMR)及与CML相关性死亡发生率等治疗效果和随访评估的作用。结果:在172例患者中,EUTOS及ELTS评分系统能较好地预测MMR的累积发生率(P<0.001,P=0.015)、OS(P<0.001,P=0.001)和PFS(P<0.001,P<0.001)。但是,Sokal和Hasford评分均未能预测伊马替尼治疗CML-CP的反应和结果(均P>0.05)。ELTS评分在因CML导致相关性死亡方面,差异具有统计学意义(P<0.010),而Sokal、Hasford和EUTOS评分系统均未见显著性差异(P=0.07,P=0.10,P=0.08),与其他3项预后评分相比,ELTS评分在预测与CML相关性死亡方面具有更高的准确性。结论:在预测伊马替尼治疗的CML患者的结局方面,EUTOS、ELTS评分系统优于Sokal、Hasford评分。新的ELTS评分可以对一线伊马替尼治疗CML患者的长期抗白血病疗效进行更好地前瞻性评估。

Objective:To compare the effectiveness of four prognostic scoring systems in predicting the efficacy and prognosis of patients newly diagnosed with chronic myeloid leukemia(CML).Identifying patients with CML at significantly low response and survival rates favors early intervention.We also evaluated the ability of the European Treatment and Outcome Study(EUTOS)long-term survival(ELTS)score as a new indicator of CML-related death.Methods:We performed a retrospective analysis of 172 patients with chronic myeloid leukemia-chronic phase(CML-CP)who received first-line treatment with imatinib at our hospital from January 2010 to December 2019.Sokal,Hasford,EUTOS,and ELTS scores were applied.The patients were divided into various risk groups,and scoring systems were compared in terms of the overall survival(OS),progression-free survival(PFS),major molecular response(MMR),CML-related deaths,other treatment effects,and impact of follow-up evaluations.Results:In 172 patients,the EUTOS and ELTS scores could better predict the cumulative incidence of MMR(P<0.001,P=0.015),OS(P<0.001,P=0.001),and PFS(P<0.001,P<0.001).However,both Sokal and Hasford scores failed to predict the response and outcome of CML after treatment with imatinib(P>0.05).ELTS scores were statistically significant in CML-related deaths(P<0.01)while Sokal,Hasford,and EUTOS scores showed no significant differences(P=0.07,P=0.10,P=0.08).ELTS scores were more accurate in predicting CML-related deaths than the other three prognostic scores.Conclusions:In predicting the outcome of patients with CML treated with imatinib,the EUTOS and ELTS scores are better than the Sokal and Hasford scores.The new ELTS score provides a better prospective assessment of the long-term anti-leukemia efficacy of first-line imatinib in patients with CML.