Wierda William G, O'Brien Susan, Wang Xuemei, Faderl Stefan, Ferrajoli Alessandra, Do Kim-Anh, Cortes Jorge, Thomas Deborah, Garcia-Manero Guillermo, Koller Charles, Beran Miloslav, Giles Francis, Ravandi Farhad, Lerner Susan, Kantarjian Hagop, Keating Michael
Department of Leukemia, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Blood. 2007 Jun 1;109(11):4679-85. doi: 10.1182/blood-2005-12-051458. Epub 2007 Feb 13.
The clinical course for patients with chronic lymphocytic leukemia is extremely heterogeneous. The Rai and Binet staging systems have been used to risk-stratify patients; most patients present with early-stage disease. We evaluated a group of previously untreated patients with chronic lymphocytic leukemia (CLL) at initial presentation to University of Texas M. D. Anderson Cancer Center to identify independent characteristics that predict for overall survival. Clinical and routine laboratory characteristics for 1674 previously untreated patients who presented for evaluation of CLL from 1981 to 2004 were included. Univariate and multivariate analyses identified several patient characteristics at presentation that predicted for overall survival in previously untreated patients with CLL. A multivariate Cox proportional hazards model was developed, including the following independent characteristics: age, beta-2 microglobulin, absolute lymphocyte count, sex, Rai stage, and number of involved lymph node groups. Inclusion of patients from a single institution and the proportion of patients younger than 65 years may limit this model. A weighted prognostic model, or nomogram, predictive for overall survival was constructed using these 6 characteristics for 5- and 10-year survival probability and estimated median survival time. This prognostic model may help patients and clinicians in clinical decision making as well as in clinical research and clinical trial design.
慢性淋巴细胞白血病患者的临床病程极不相同。Rai分期系统和Binet分期系统已被用于对患者进行风险分层；大多数患者表现为疾病早期。我们评估了一组初诊时前往德克萨斯大学MD安德森癌症中心就诊的未经治疗的慢性淋巴细胞白血病（CLL）患者，以确定预测总生存期的独立特征。纳入了1981年至2004年期间前来评估CLL的1674例未经治疗患者的临床和常规实验室特征。单因素和多因素分析确定了初诊时的几个患者特征，这些特征可预测未经治疗的CLL患者的总生存期。构建了一个多因素Cox比例风险模型，包括以下独立特征：年龄、β2微球蛋白、绝对淋巴细胞计数、性别、Rai分期和受累淋巴结组数量。纳入来自单一机构的患者以及65岁以下患者的比例可能会限制该模型。利用这6个特征构建了一个预测总生存期的加权预后模型或列线图，用于预测5年和10年生存概率以及估计中位生存时间。该预后模型可能有助于患者和临床医生进行临床决策以及临床研究和临床试验设计。
