Baillargeon Jacques, Langevin Anne-Marie, Lewis Margaret, Estrada Jaime, Mullins Judith, Pitney Aaron, Ma Jennie Z, Chisholm Gary B, Pollock Brad H
Department of Epidemiology and Biostatistics, University of Texas Health Science Center, (UTHSCSA), Center at San Antonio, San Antonio, TX 78229-3900, USA.
J Pediatr Hematol Oncol. 2006 Sep;28(9):575-8. doi: 10.1097/01.mph.0000212985.33941.d8.
Acute lymphoblastic leukemia (ALL), the most common malignancy in children, constitutes 25% of all pediatric cancer. Childhood cancer patients who are obese at diagnosis represent a particular challenge for the oncologist. Obesity may complicate chemotherapy dose determination, and has been associated with decreased overall and event-free survival in a number of adult cancer patients, and more recently in pediatric patients. The purpose of the present study was to examine whether obesity at diagnosis was associated with decreased overall and event-free survival in a cohort of 322 predominantly Hispanic pediatric patients with B-precursor ALL. Obesity was classified as an age-standardized and sex-standardized body mass index z-score at or above the 95th percentile. Hazard ratios (HRs) for overall and event-free survival were assessed using Cox proportional hazards regression modeling. Obesity at diagnosis was not associated with decreased overall survival (HR = 1.40, 95% confidence interval = 0.69-2.87) or event-free survival (HR = 1.08, 95% confidence interval = 0.65-1.82) in the overall cohort or in either of the 2 age-at-diagnosis (2 to 9 y; 10 to 18 y) subgroups. Our finding of no obesity-related prognostic effect in the overall cohort and in the under 2 to 9-year age-at-diagnosis cohort was consistent with the previous large-scale study of ALL patients; the absence of a prognostic effect in the 10 to 18-year age-at-diagnosis cohort, however, conflicted with previous findings.
急性淋巴细胞白血病（ALL）是儿童中最常见的恶性肿瘤，占所有儿童癌症的25%。诊断时肥胖的儿童癌症患者对肿瘤学家来说是一个特殊的挑战。肥胖可能会使化疗剂量的确定复杂化，并且在许多成年癌症患者中，最近在儿科患者中，肥胖与总体生存率和无事件生存率的降低有关。本研究的目的是检查在322名主要为西班牙裔的B前体ALL儿科患者队列中，诊断时的肥胖是否与总体生存率和无事件生存率的降低有关。肥胖被定义为年龄标准化和性别标准化的体重指数z评分在第95百分位数及以上。使用Cox比例风险回归模型评估总体生存率和无事件生存率的风险比（HRs）。在整个队列中，以及在两个诊断年龄（2至9岁；10至18岁）亚组中的任何一个亚组中，诊断时的肥胖与总体生存率降低（HR = 1.40，95%置信区间 = 0.69 - 2.87）或无事件生存率降低（HR = 1.08，95%置信区间 = 0.65 - 1.82）均无关。我们在整个队列以及2至9岁诊断年龄队列中未发现肥胖相关预后影响的结果与之前对ALL患者的大规模研究一致；然而，在10至18岁诊断年龄队列中未发现预后影响与之前的研究结果相矛盾。
