Hyakuna N, Kaneko Y, Katano N, Iwai T, Nagata T, Sakashita K, Takeda O, Tanaka A, Azuma H, Sekine I, Fujimoto T
Rinsho Ketsueki. 2000 Jul;41(7):576-84.
We analyzed the prognostic significance of chromosomal findings in children with acute lymphoblastic leukemia (ALL), treated according to the Children's Cancer and Leukemia Study Group protocols between 1987 and 1993. Patients were classified into 5 groups according to chromosome number. The patients with a hyperdiploid(> 50) karyotype(13%) had the best prognosis [4-year event-free survival (EFS): 83 +/- 6%], while those with a pseudodiploid karyotype (24%) had the worst prognosis(4-year EFS: 52 +/- 6%) (log-rank, p = 0.03). However, multivariate analysis revealed that the ploidy classification had no prognostic significance in terms of EFS. When patients were classified according to chromosome abnormalities, those with any type of translocation had a worse outcome (4-year EFS: 33 +/- 9%) than those with hyperdiploidy(> 50), normal diploidy, and other abnormalities(log-rank, p < 0.0001). Multivariate analysis revealed that chromosome abnormalities were an independent prognostic factor (relative risk 3.98; p < 0.0001). Patients with t(1; 19) had an EFS similar to that of patients with chromosome abnormalities other than translocations or normal diploidy. We conclude that chromosomal findings have prognostic significance, although some chromosome abnormalities lost their statistical significance after modern intensified chemotherapy. Childhood ALL should be further stratified according to chromosome classification.
我们分析了1987年至1993年间按照儿童癌症与白血病研究组方案治疗的急性淋巴细胞白血病（ALL）患儿染色体检查结果的预后意义。根据染色体数目将患者分为5组。超二倍体（>50）核型的患者（13%）预后最佳[4年无事件生存率（EFS）：83±6%]，而假二倍体核型的患者（24%）预后最差（4年EFS：52±6%）（对数秩检验，p = 0.03）。然而，多因素分析显示，就EFS而言，倍性分类无预后意义。当根据染色体异常对患者进行分类时，任何类型易位的患者预后（4年EFS：33±9%）均比超二倍体（>50）、正常二倍体及其他异常的患者差（对数秩检验，p < 0.0001）。多因素分析显示，染色体异常是独立的预后因素（相对风险3.98；p < 0.0001）。t(1; 19)患者的EFS与除易位或正常二倍体之外的染色体异常患者相似。我们得出结论，尽管现代强化化疗后一些染色体异常失去了统计学意义，但染色体检查结果仍具有预后意义。儿童ALL应根据染色体分类进一步分层。
