Viana Simone Santana, de Lima Leyla Manoella Maurício Rodrigues, do Nascimento Juliana Brito, Cardoso Carlos André Ferreira, Rosário Ana Carolina Dantas, Mendonça Cristiano de Queiroz, de Menezes-Neto Osvaldo Alves, Cipolotti Rosana
Federal University of Sergipe, Brazil.
Leuk Res. 2015 Oct;39(10):1060-5. doi: 10.1016/j.leukres.2015.07.007. Epub 2015 Jul 26.
The treatment for ALL has evolved in recent decades and as a result survival rates are now close to 90% in many developed countries. However, this is not the case in developing countries where survival rates are often below 35%. More than 80% of children who are affected by ALL worldwide live in developing countries. The objective of this study was to evaluate the secular trend in mortality for children with ALL living in Sergipe, a state in northeastern Brazil, and to investigate any association with variables that relate to socioeconomic status.
This study evaluated ALL patients who were less than 20 years of age and who were treated at the Dr. Osvaldo Leite Oncology Center in the capital city, Aracaju. The sample comprised two cohorts of patients from the public health service: patients treated from 1980 to 2004 (cohort A) and from 2005 to 2014 (cohort B). The findings were compared to those of patients treated in the one private service for pediatric cancer treatment available in the region, from 2005 to 2014 (cohort C). Two categories of variables were considered in this study: biological and socioeconomic.
We analyzed 412 patients who were divided into three cohorts (cohort A: 287 patients, cohort B: 106 patients and cohort C: 19 patients). The mortality rates for the three cohorts were significantly different: 57.5% in cohort A, 45.3% in cohort B and 26.3% in cohort C (p=0.006). Mortality during induction in cohort B was 22.6%, while in cohort C no deaths occurred during this phase (p=0.041). Patients living in rural areas had higher mortality rates (p=0.036).
The reduction in deaths from infection during induction seems to be the starting point for improving the chances for children and adolescents with ALL anywhere in the world.
近几十年来，急性淋巴细胞白血病（ALL）的治疗方法不断发展，因此在许多发达国家，其生存率目前已接近90%。然而，发展中国家的情况并非如此，其生存率往往低于35%。全球超过80%受ALL影响的儿童生活在发展中国家。本研究的目的是评估巴西东北部塞尔希培州ALL患儿的长期死亡率趋势，并调查其与社会经济地位相关变量之间的任何关联。
本研究评估了年龄小于20岁且在首府阿拉卡茹的奥斯瓦尔多·莱特博士肿瘤中心接受治疗的ALL患者。样本包括来自公共卫生服务机构的两组患者队列：1980年至2004年接受治疗的患者（队列A）和2005年至2014年接受治疗的患者（队列B）。将研究结果与该地区2005年至2014年唯一一家提供儿科癌症治疗的私立服务机构治疗的患者（队列C）的结果进行比较。本研究考虑了两类变量：生物学变量和社会经济变量。
我们分析了412例患者，他们被分为三个队列（队列A：287例患者，队列B：106例患者，队列C：19例患者）。三个队列的死亡率有显著差异：队列A为57.5%，队列B为45.3%，队列C为26.3%（p=0.006）。队列B诱导期的死亡率为22.6%，而队列C在此阶段无死亡发生（p=0.041）。居住在农村地区的患者死亡率较高（p=0.036）。
诱导期感染死亡人数的减少似乎是提高世界各地ALL儿童和青少年生存几率的起点。
