84例老年急性髓系白血病患者的临床特点及预后分析

Clinical Characteristics and Prognosis of 84 Elderly Patients with Acute Myeloid Leukemia

目的:探讨老年AML患者的预后因子,以及老年综合评估在中国老年AML患者中的应用及预后价值,从而确定适合中国人的预测生存并指导治疗选择的老年综合评估方法。方法:回顾性分析2007年10月至2017年12月我科诊断的年龄≥60岁的84例AML患者的病历资料,分析临床、病理以及老年综合评估相关预后因子。结果:所有患者的中位年龄70(60-91)岁,男女比例为:1. 9∶1(55∶29),中位OS为9(1-125)个月,1年OS率为35. 3%,5年OS率为12. 6%。年龄分组、第1疗程缓解状态、是否难治复发、初诊白细胞数分组、乳酸脱氢酶和血肌酐水平是影响OS的危险因素;第1疗程缓解状态、是否难治复发、初诊白细胞数分组、乳酸脱氢酶水平、初诊是否合并感染、ECOG评分是影响DFS的危险因素。老年患者合并症的评估,charlson合并症指数(charlson comorbidity index,CCI) 2分法是影响OS的危险因素,但对于DFS的影响无统计学差异;而造血细胞移植合并症指数(HCT-CI) 3分法、老年性疾病累积评分量表(CIRS-G)的4分法和3分法对于OS及DFS的影响均无统计学差异;老年患者综合评估的年龄、合并症和白蛋的(ACA)指数对OS、DFS的影响均有统计学意义。患者自身因素相关各指标以及疾病相关因素各指标均不是影响OS和DFS的独立预后因素,故对于预后的判断需进行综合评估。结论:老年AML患者预后的判断以及治疗选择需综合地考虑临床、病理以及老年综合评估各个方面因素。

Objective:To explore the prognostic factors of elderly AML patients,as well as the application and prognostic value of comprehensive geriatric assessment(CGA)in elderly AML patients in China,so as to determine a suitable comprehensive assessment method that can predict survival and guide treatment of patients in Chinese people.Methods:Retrospective analysis was performed on the medical records of 84 AML patients aged over 60 years old,and diagnosed in our department from October 2007 to December 2017,and the clinical,pathological and comprehensive evaluation of related prognostic factors was analyzed.Results:The median age of all patients was 70(60-91)years old,ratio of male to female was 1.9:1(55:29),the median OS time was 9(1-125)months,1 year OS rate was 35.3%,and 5 year OS rate was 12.6%.The age grouping,remission of induction chemotherapy,whether refractory/relapse,WBC count grouping at initial diagnosis,levels of lactate dehydrogenase and creatinine were risk factors for OS.Remission of induction chemotherapy,whether refractory/relapse,WBC count grouping and co-infections at initial diagnosis,levels of lactate dehydrogenase,and ECOG score were the risk factors for DFS.In the assessment of comorbidities,the two score classifications of charlson comorbidity index(CCI)were the risk factor of OS,how ever,whose effects for DFS were not statistically different.The effects of 3 score classifications of hemaotopoietic cell transplantation comorbidity index(HCTCI),4 score classifications of comulative illness kating scale for geriatrics(CIRS-G)and 3 score classifications of CRS-G on OS and DFS were not statistically different.The impact of the AC A index on OS and DFS was statistically significant in elderly patients.All indexes related with patients self factors and disease-related factors were no independent prognostic factors for OS and DFS,so the judgment of prognosis needs to be comprehensively evaluated.Conclusion:The prognosis and treatment selection of elderly AML patients should be combined with traditional clinical and pathological prognostic factors as well as comprehensive assessment of the elderly patients.