Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon, France.
German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Obere Zahlbacher Strasse 69, 55101 Mainz, Germany.
Eur J Cancer. 2014 May;50(7):1345-53. doi: 10.1016/j.ejca.2014.01.028. Epub 2014 Feb 28.
Sex, age, immunophenotype and white blood cell count at diagnosis are well accepted predictors of survival from acute lymphoblastic leukaemia (ALL) in children. Less is known about the relationship between socio-economic determinants and survival from paediatric ALL, studied here for the first time in German children.
ALL cases were diagnosed between 1992 and 1994 and their parents interviewed during a previous nationwide case-control study. Children were followed-up for 10 years after diagnosis by the German Childhood Cancer Registry. Cox proportional hazards models estimating hazard ratios (HRs) were calculated to assess the impact of selected socio-demographic characteristics on overall and event-free survival.
Overall survival was 82.5%, with a higher proportion of girls than boys surviving (85% versus 81%). We found a non-linear relationship between age at diagnosis and survival, with poorer survival in infants and children aged >5 years. There was no association between socio-economic factors and survival or risk of relapse. For five levels of increasing family income, all HRs were close to one. No relationship was seen with parental educational level.
Socio-economic determinants did not affect ALL survival in West German children, in contrast to studies from some other countries. Dissimilarities in social welfare systems, including access to health care, lifestyle and differences in treatment may contribute to these differences in findings. Our observation of no social inequalities in paediatric ALL survival is reassuring, but needs continued monitoring to assess the potential impact of evolvement of treatment options and changes in paediatric health service.
性别、年龄、免疫表型和诊断时的白细胞计数是儿童急性淋巴细胞白血病（ALL）生存的公认预测因素。关于社会经济决定因素与儿科 ALL 生存之间的关系，了解较少，本研究首次在德国儿童中对此进行了研究。
所有病例均于 1992 年至 1994 年间确诊，并在之前的全国病例对照研究中对其父母进行了访谈。儿童在诊断后通过德国儿童癌症登记处进行了 10 年的随访。使用 Cox 比例风险模型估计风险比（HRs）来评估选定的社会人口统计学特征对总生存和无事件生存的影响。
总生存率为 82.5%，女孩的生存率高于男孩（85%对 81%）。我们发现诊断时的年龄与生存率之间存在非线性关系，婴儿和年龄>5 岁的儿童生存率较差。社会经济因素与生存率或复发风险之间没有关联。对于家庭收入逐渐增加的五个水平，所有 HR 均接近 1。与父母的教育水平没有关系。
与来自其他一些国家的研究相反，社会经济决定因素并未影响西德儿童的 ALL 生存率。社会福利制度的差异，包括获得医疗保健、生活方式和治疗方面的差异，可能导致这些发现存在差异。我们观察到儿科 ALL 生存率没有社会不平等是令人放心的，但需要继续监测，以评估治疗选择演变和儿科卫生服务变化的潜在影响。
