Division of Haematology/Oncology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Eur J Cancer. 2014 May;50(8):1482-9. doi: 10.1016/j.ejca.2014.02.021. Epub 2014 Mar 19.
Traumatic lumbar punctures with blasts (TLP+) in children with acute lymphoblastic leukaemia (ALL) obscure central nervous system status and are associated with a poorer event-free survival (EFS).
We conducted a retrospective cohort study of all lumbar punctures (LPs) for children with ALL diagnosed at our institution from 2005 to 2009. We utilised random-effects and fixed-effects repeated-measures logistic regression analyses to identify risk factors for TLPs. Fixed-effects models use each patient as his or her own control. We used survival analysis to describe outcomes after a TLP+.
264 children underwent 5267 evaluable lumbar punctures (LPs), of which 944 (17.9%) were traumatic. In the multivariable random-effects model, variables significantly associated with TLPs were age <1year (odds ratio (OR) 3.46, 95% confidence interval (CI) 2.06-5.81) or age ⩾10years (OR 2.00, CI 1.66-2.40); body mass index percentile ⩾95 (OR 1.44, CI 1.19-1.75); platelet count <100×10(3)/μL (OR 1.49, CI 1.08-20.7); fewer days since previous LP (OR 5.13, CI 2.34-11.25 for ⩾16days versus 0-3days); and a preceding TLP (OR 1.43, CI 1.19-1.73). In the fixed-effects model, image-guidance reduced the odds of TLP (OR 0.55, CI 0.32-0.95). The 5-year EFS (±SE) for children with TLP+ (77±8%) was significantly lower than for children with CNS1 status (93±2%; p=0.002).
The frequency of TLP remains high. Consistent with previous studies, a TLP+ at diagnosis was associated with a poorer EFS. These risk factors can allow identifying interventions to reduce TLPs and directing interventions to those at highest risk.
伴有爆炸的创伤性腰椎穿刺（TLP+）在急性淋巴细胞白血病（ALL）患儿中会掩盖中枢神经系统状态，并与较差的无事件生存（EFS）相关。
我们对 2005 年至 2009 年在我院诊断为 ALL 的所有儿童进行了一项回顾性队列研究。我们使用随机效应和固定效应重复测量逻辑回归分析来确定 TLP 的危险因素。固定效应模型使用每个患者作为自己的对照。我们使用生存分析来描述 TLP+后的结果。
264 名儿童进行了 5267 次可评估的腰椎穿刺（LP），其中 944 次（17.9%）为创伤性。在多变量随机效应模型中，与 TLP 显著相关的变量为年龄<1 岁（比值比（OR）3.46，95%置信区间（CI）2.06-5.81）或年龄⩾10 岁（OR 2.00，CI 1.66-2.40）；体重指数百分比 ⩾95（OR 1.44，CI 1.19-1.75）；血小板计数<100×103/μL（OR 1.49，CI 1.08-20.7）；距上次 LP 时间较长（OR 5.13，CI 2.34-11.25，与 0-3 天相比，⩾16 天）；以及先前的 TLP（OR 1.43，CI 1.19-1.73）。在固定效应模型中，图像引导降低了 TLP 的几率（OR 0.55，CI 0.32-0.95）。TLP+患儿的 5 年 EFS（±SE）为 77±8%，显著低于 CNS1 状态患儿的 93±2%（p=0.002）。
TLP 的频率仍然很高。与以往研究一致，诊断时的 TLP+与较差的 EFS 相关。这些危险因素可以识别干预措施来减少 TLP，并将干预措施指向风险最高的患者。
