Department of Hematology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
Clinical Trial Center, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
Leuk Res. 2015 Feb;39(2):177-82. doi: 10.1016/j.leukres.2014.11.025. Epub 2014 Dec 4.
Myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML) may be underreported in cancer registries such as the Netherlands Cancer Registry (NCR). Analysis of Dutch medical claims can complement NCR data on MDS and CMML. We analyzed data on 3681 MDS patients and 235 CMML patients aged ≥18 years with initial claims for MDS or CMML from the Dutch nationwide medical claims-based Diagnosis Treatment Combination Information System (DIS) between 2008 and 2010. Clinical information was available in the DIS. MDS and CMML were diagnosed without a bone marrow (BM) examination in almost half of the patients. The age-standardized incidence rate (ASR) per 100,000 in the cohort that underwent BM examinations compared with NCR data was 2.8 vs. 3.3 for MDS and 0.2 vs. 0.4 for CMML in 2008-2010. A conservative treatment approach was associated with increasing age and absence of BM examination in MDS (p<0.001 for both) and CMML patients (p<0.033 for both). In conclusion, the ASR of MDS in the cohort that underwent BM examinations was comparable with the NCR. The majority of elderly patients, either with or without BM examinations, received no therapy. Together, MDS and CMML may be misdiagnosed and inappropriately managed without a BM confirmation.
骨髓增生异常综合征（MDS）和慢性粒单核细胞白血病（CMML）在癌症登记处（如荷兰癌症登记处）可能报告不足。对荷兰医疗索赔的分析可以补充 MDS 和 CMML 的 NCR 数据。我们分析了 2008 年至 2010 年间来自荷兰全国性基于医疗索赔的诊断治疗组合信息系统（DIS）的 3681 例 MDS 患者和 235 例年龄≥18 岁的初始 MDS 或 CMML 索赔的 CMML 患者的数据。DIS 中提供了临床信息。在近一半的患者中，MDS 和 CMML 的诊断未进行骨髓（BM）检查。与 NCR 数据相比，接受 BM 检查的队列中的年龄标准化发病率（ASR）为每 10 万人 2.8 与 MDS 相比为 3.3，2008-2010 年为 0.2 与 CMML 相比为 0.4。在 MDS（均<0.001）和 CMML 患者中（均<0.033），保守治疗方法与年龄增加和缺乏 BM 检查相关。总之，接受 BM 检查的队列中 MDS 的 ASR 与 NCR 相当。大多数老年患者，无论是否进行 BM 检查，都未接受治疗。总之，MDS 和 CMML 可能未经 BM 确认而误诊和不当治疗。
