Bona Kira, Blonquist Traci M, Neuberg Donna S, Silverman Lewis B, Wolfe Joanne
Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
Pediatr Blood Cancer. 2016 Jun;63(6):1012-8. doi: 10.1002/pbc.25928. Epub 2016 Feb 23.
Population-based evidence suggests that lower socioeconomic status (SES) negatively impacts the overall survival (OS) of children with leukemia; however, the relationships between SES and treatment-related mortality, relapse, and timing of relapse remain unclear.
We examined OS, event-free survival (EFS) and cumulative incidence (CI) and timing of relapse by community-level poverty for 575 children aged 1-18 years with newly diagnosed acute lymphoblastic leukemia (ALL) treated on consecutive phase III multicenter Dana-Farber Cancer Institute ALL Consortium Protocols between 2000 and 2010. Children were categorized into high- and low-poverty areas for the analysis using aggregate U.S. Census data linked to zip code.
Children living in high-poverty areas experienced a 5-year OS of 85% as compared with 92% for those in low-poverty areas (P = 0.02); poverty remained marginally significant (P = 0.07) after adjustment for immunophenotype, age, and white blood cell count. There were no differences detected in EFS or CI relapse by poverty area. However, 92% of the relapses observed in children from high-poverty areas occurred <36 months from complete remission, compared to 48% of those in children from low-poverty areas (P = 0.008).
U.S. children with ALL living in high-poverty areas have a higher risk of early relapse when compared with those living in low-poverty areas despite uniform treatment. This may in part explain decreased OS observed in these children. This finding highlights disparities in childhood cancer outcomes by SES despite uniform treatment. Further investigations of the mechanistic pathways underlying this finding are needed.
基于人群的证据表明，社会经济地位（SES）较低对白血病患儿的总生存期（OS）有负面影响；然而，SES与治疗相关死亡率、复发及复发时间之间的关系仍不明确。
我们通过社区层面的贫困程度，对2000年至2010年间在连续的III期多中心达纳-法伯癌症研究所ALL联盟方案中接受治疗的575名1至18岁新诊断急性淋巴细胞白血病（ALL）患儿的OS、无事件生存期（EFS）、累积发病率（CI）及复发时间进行了研究。利用与邮政编码相关的美国人口普查汇总数据，将患儿分为高贫困地区和低贫困地区进行分析。
生活在高贫困地区的患儿5年总生存率为85%，而生活在低贫困地区的患儿为92%（P = 0.02）；在对免疫表型、年龄和白细胞计数进行调整后，贫困因素仍具有边缘显著性（P = 0.07）。贫困地区之间在EFS或CI复发方面未检测到差异。然而，高贫困地区患儿中92%的复发发生在完全缓解后<36个月，而低贫困地区患儿中这一比例为48%（P = 0.008）。
尽管接受统一治疗，但与生活在低贫困地区的美国ALL患儿相比，生活在高贫困地区的患儿早期复发风险更高。这可能部分解释了这些患儿总生存期降低的原因。这一发现凸显了尽管接受统一治疗，但儿童癌症结局仍存在社会经济地位差异。需要对这一发现背后的机制途径进行进一步研究。
