Molica S, Levato D
Divisione Ematologia e Oncologia Clinica, Azienda Ospedaliera Pugliese-Ciaccio, viale Pio X, 88100 Catanzaro, Italy.
Haematologica. 2001 Jan;86(1):8-12.
In the last few years there has been a trend towards an improvement in overall survival of patients with chronic lymphocytic leukemia (CLL). Studies based on tumor registries of the general population or including patients referred to hematologic institutions have analyzed reasons for these changes. However, results need to be validated on independent series.
We retrospectively evaluated 518 CLL patients diagnosed at our institution between January 1970 and December 1998. In this cohort of patients we looked at characteristics affecting natural history such as age and sex distribution, stage at diagnosis, survival probability and impact of the disease status on the actuarial survival. Trends in these variables were analyzed after splitting the whole series into three groups according to the period in which the diagnosis was made. Group I consisted of 75 patients diagnosed between 1970 and 1979, group II consisted of 149 patients diagnosed in the period 1980--1989, group III was composed of 293 patients diagnosed between 1991 and 1998.
Age and sex distribution did not reflect different periods of diagnosis. The proportion of patients in whom diagnosis was established in low clinical stage (stage A) was higher in the group III (72%) than in groups I or II (26.3% and 50.3%, respectively) (p < 0.0001). Differences in the stage distribution affected life-expectancy which was longer for patients diagnosed in the nineties (median survival, 93 months) than in those diagnosed in the eighties (median survival, 54 months) or in the seventies (median survival, 38 months) (p < 0.0001). Finally, survival analyses by stage showed an improvement of life-expectancy when dealing with patients of high risk category (p =0.005).
CLL patients diagnosed in the last decade enjoy the best clinical outcome, mostly as a result of a greater proportion of patients in the low-risk clinical stage and a relatively longer survival of the high risk group. It is not clear whether these changes represent true modifications of the natural history of CLL. At the beginning of the third millennium CLL continues to be a fatal disease with a significant impact on life-expectancy.
在过去几年中，慢性淋巴细胞白血病（CLL）患者的总体生存率呈上升趋势。基于普通人群肿瘤登记处的研究或纳入血液学机构转诊患者的研究分析了这些变化的原因。然而，结果需要在独立队列中进行验证。
我们回顾性评估了1970年1月至1998年12月在我院确诊的518例CLL患者。在这个患者队列中，我们研究了影响自然病程的特征，如年龄和性别分布、诊断时的分期、生存概率以及疾病状态对精算生存的影响。根据诊断时间将整个队列分为三组后，分析了这些变量的趋势。第一组由1970年至1979年确诊的75例患者组成，第二组由1980年至1989年确诊的149例患者组成，第三组由1991年至1998年确诊的293例患者组成。
年龄和性别分布并未反映出不同的诊断时期。第三组中临床低分期（A期）确诊患者的比例（72%）高于第一组（26.3%）和第二组（分别为50.3%）（p<0.0001）。分期分布的差异影响了预期寿命，90年代确诊的患者预期寿命更长（中位生存期93个月），高于80年代确诊的患者（中位生存期54个月）或70年代确诊的患者（中位生存期38个月）（p<0.0001）。最后，按分期进行的生存分析显示，高危组患者的预期寿命有所改善（p=0.005）。
过去十年确诊的CLL患者临床结局最佳，这主要是由于低风险临床分期患者比例较高以及高危组患者生存期相对较长。尚不清楚这些变化是否代表CLL自然病程的真正改变。在第三个千年伊始，CLL仍然是一种致命疾病，对预期寿命有重大影响。
