Butturini Anna M, Dorey Frederick J, Lange Beverly J, Henry David W, Gaynon Paul S, Fu Cecilia, Franklin Janet, Siegel Stuart E, Seibel Nita L, Rogers Paul C, Sather Harland, Trigg Michael, Bleyer W Archie, Carroll William L
Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA.
J Clin Oncol. 2007 May 20;25(15):2063-9. doi: 10.1200/JCO.2006.07.7792.
To evaluate the effect of obesity (defined as a body mass index > 95th percentile for age and sex at diagnosis) on outcome of pediatric acute lymphoblastic leukemia (ALL).
We retrospectively analyzed data from 4,260 patients with newly diagnosed ALL enrolled from 1988 to 1995 onto five concurrent Children's Cancer Group studies. Results were verified in a second cohort of 1,733 patients enrolled onto a sixth study from 1996 to 2002.
The 1988 to 1995 cohort included 343 obese and 3,971 nonobese patients. The 5-year event-free survival rate and risk of relapse in obese versus nonobese patients were 72% +/- 2.4% v 77% +/- 0.6% (P = .02) and 26 +/- 2.4 v 20 +/- 0.6 (P = .02), respectively. After adjusting for other prognostic variables, obesity's hazard ratios (HRs) of events and relapses were 1.36 (95% CI, 1.04 to 1.77; P = .021) and 1.29 (95% CI, 1.02 to 1.56; P = .04), respectively. The effect of obesity was prominent in the 1,003 patients > or = 10 years old at diagnosis; in this subset, obesity's adjusted HRs of events and relapses were 1.5 (95% CI, 1.1 to 2.1; P = .009) and 1.5 (95% CI, 1.2 to 2.1; P = .013), respectively. In a second cohort of 1,160 patients 10 years old, obesity's adjusted HRs of events and relapses were 1.42 (95% CI, 1.03 to 1.96; P = .032) and 1.65 (95% CI, 1.13 to 2.41; P = .009), respectively. The effect of obesity on outcome was unrelated to changes in chemotherapy doses, length of intervals between chemotherapy cycles, or incidence and severity of therapy-related toxicity.
Obesity at diagnosis independently predicts likelihood of relapse and cure in preteenagers and adolescents with ALL.
评估肥胖（定义为诊断时年龄和性别的体重指数高于第95百分位数）对儿童急性淋巴细胞白血病（ALL）预后的影响。
我们回顾性分析了1988年至1995年入组五项同期儿童癌症组研究的4260例新诊断ALL患者的数据。结果在1996年至2002年入组第六项研究的1733例患者的第二个队列中得到验证。
1988年至1995年队列包括343例肥胖患者和3971例非肥胖患者。肥胖患者与非肥胖患者的5年无事件生存率和复发风险分别为72%±2.4%对77%±0.6%（P = 0.02）和26±2.4对20±0.6（P = 0.02）。在调整其他预后变量后，肥胖对事件和复发的风险比（HR）分别为1.36（95%CI，1.04至1.77；P = 0.021）和1.29（95%CI，1.02至1.56；P = 0.04）。肥胖的影响在诊断时年龄≥10岁的1003例患者中尤为突出；在该亚组中，肥胖对事件和复发的调整后HR分别为1.5（95%CI，1.1至2.1；P = 0.009）和1.5（95%CI，1.2至2.1；P = 0.013）。在第二个队列的1160例10岁患者中，肥胖对事件和复发的调整后HR分别为1.42（95%CI，1.03至1.96；P = 0.032）和1.65（95%CI，1.13至2.41；P = 0.009）。肥胖对预后的影响与化疗剂量的变化、化疗周期之间的间隔时间长度或治疗相关毒性的发生率和严重程度无关。
诊断时肥胖独立预测青少年ALL患者的复发可能性和治愈率。
