Department of Hematology/Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Viale Pio X 88100 Catanzaro, Italy.
Haematologica. 2010 Mar;95(3):464-9. doi: 10.3324/haematol.2009.011767. Epub 2009 Nov 10.
A prognostic index based on widely available clinical and laboratory features was recently proposed to predict survival in patients with previously untreated chronic lymphocytic leukemia. We assessed the utility of this index for predicting time to first treatment in early chronic lymphocytic leukemia.
An observational database of the GIMEMA (Gruppo Italiano Malattie EMatologiche dell'Adulto), which included 310 patients with newly diagnosed Binet stage A chronic lymphocytic leukemia who were observed at different primary hematology centers during the period 1991 - 2000, was used for the purpose of this study.
The new prognostic index enabled Binet stage A patients to be divided into two subgroups that differed with respect to time to first treatment (P=0.003). The original prognostic index was derived from a database that included cases observed at a reference academic center; these patients were younger (P<0.0001) and had more advanced disease (P<0.0001) than those in the current investigation, which studied community-based patients whose data were recorded at presentation. With this in mind, we used an optimal cut-off search to determine how best to split patients with Binet stage A disease into different prognostic groups. According to the recursive partitioning (RPART) model, a classification tree was built that identified three subsets of patients who scores were 0-2 (low risk), 3-4 (intermediate risk) and 5-7 (high risk). The probability of remaining free from therapy at 5 years was 100% in the low risk group, 81.2% in the intermediate risk group and 61.3% in the high risk group (P<0.0001).
The results of this study confirm the utility of a new prognostic index for predicting time to first treatment in a large sample series of community-based patients with early stage chronic lymphocytic leukemia at presentation. Our effort to develop a revised scoring method meets the need to separate Binet stage A patients into different prognostic groups in order to devise individualized and tailored follow-up during the treatment-free period.
最近提出了一种基于广泛可用的临床和实验室特征的预后指数，用于预测未经治疗的慢性淋巴细胞白血病患者的生存情况。我们评估了该指数在预测早期慢性淋巴细胞白血病首次治疗时间中的效用。
本研究使用了 GIMEMA（Gruppo Italiano Malattie EMatologiche dell'Adulto）的观察性数据库，该数据库包括 310 名新诊断为 Binet 期 A 慢性淋巴细胞白血病的患者，他们在 1991 年至 2000 年期间在不同的初级血液病中心接受观察。
新的预后指数使 Binet 期 A 患者能够分为两个亚组，这两个亚组在首次治疗时间上有所不同（P=0.003）。原始的预后指数是从一个包括在参考学术中心观察到的病例的数据库中得出的；这些患者比目前研究中的患者更年轻（P<0.0001）且疾病更晚期（P<0.0001），因为目前的研究是针对社区为基础的患者，其数据是在就诊时记录的。考虑到这一点，我们使用最优分割搜索来确定如何最好地将 Binet 期 A 疾病患者分为不同的预后组。根据递归分区（RPART）模型，构建了一个分类树，该树确定了评分 0-2（低危）、3-4（中危）和 5-7（高危）的三个患者亚组。低危组的 5 年无治疗生存率为 100%，中危组为 81.2%，高危组为 61.3%（P<0.0001）。
这项研究的结果证实了一种新的预后指数在预测大型社区为基础的早期慢性淋巴细胞白血病患者首次治疗时间中的效用。我们努力开发一种修订后的评分方法，以满足将 Binet 期 A 患者分为不同预后组的需要，以便在无治疗期间制定个体化和量身定制的随访计划。
