Master Samip, Mansour Richard, Devarakonda Srinivas S, Shi Zhenzhen, Mills Glenn, Shi Runhua
Department of Medicine & Feist-Weiller Cancer Center, Louisiana State University Health Shreveport, Shreveport, LA, U.S.A.
Weill Cornell Medical College, New York, NY, U.S.A.
Anticancer Res. 2016 Apr;36(4):1719-27.
BACKGROUND/AIM: Evaluations of efficacy of treatment modality in analyses on patients with acute myeloid leukemia (AML) often combine chemotherapy and stem cell transplantation (SCT). To account for the effect of SCT and determine the impact of chemotherapy alone, the National Cancer Data Base from 1998-2011 was analyzed.
Patients with AML from 1998-2011 aged 18-64 years were included. Chi-square analysis was used to assess the association between treatment and factors investigated. The Kaplan-Meier method was used to assess overall survival. Log-rank methods were used to determine factors significant for survival. Multivariable Cox regression analysis was used to determine the effect of chemotherapy alone, and both chemotherapy and SCT on survival while adjusting for other variables.
A total of 34,816 patients from the National Cancer Database were eligible for this study. Eighty-four percent of patients received chemotherapy alone, 8.3% no chemotherapy or SCT, and 7.5 % received both chemotherapy and SCT. Five-year survival for patients without chemotherapy without SCT was 12%, survival for the group treated with chemotherapy alone was 37.8% and for those receiving both chemotherapy and SCT was 44.1%. Treatment with chemotherapy only and chemotherapy plus SCT had a hazard ratio for death of 0.42 and 0.35 compared to no chemotherapy or SCT. Advanced age, male sex, Black race, diagnosis prior to 2004, multiple comorbidities, Medicare insurance, Medicaid insurance, no insurance, lower income and low education level, distance less than 30 miles from treatment Center, diagnosis and treatment at same facility, were independently associated with worse survival.
Survival analysis of AML in the National Cancer Database showed multiple factors to be independently associated with survival. Outcomes based on treatment suggest an improved survival when utilizing chemotherapy and SCT as the primary treatment modality.
背景/目的：在对急性髓系白血病（AML）患者的分析中，治疗方式疗效评估通常将化疗与干细胞移植（SCT）相结合。为了考量SCT的影响并确定单纯化疗的作用，对1998 - 2011年的国家癌症数据库进行了分析。
纳入1998 - 2011年年龄在18 - 64岁的AML患者。采用卡方分析评估治疗与所研究因素之间的关联。采用Kaplan - Meier方法评估总生存期。采用对数秩检验方法确定对生存有显著影响的因素。多变量Cox回归分析用于确定单纯化疗以及化疗和SCT两者对生存的影响，同时对其他变量进行校正。
国家癌症数据库中共有34816例患者符合本研究条件。84%的患者仅接受化疗，8.3%未接受化疗或SCT，7.5%接受了化疗和SCT。未接受化疗和SCT的患者5年生存率为12%，单纯接受化疗组的生存率为37.8%，接受化疗和SCT的患者生存率为44.1%。与未接受化疗或SCT相比，单纯化疗以及化疗加SCT的死亡风险比分别为0.42和0.35。高龄、男性、黑人种族、2004年前诊断、多种合并症、医疗保险、医疗补助保险、无保险、低收入和低教育水平、距离治疗中心小于30英里、在同一机构诊断和治疗，均与较差的生存独立相关。
国家癌症数据库中AML的生存分析显示多个因素与生存独立相关。基于治疗的结果表明，将化疗和SCT作为主要治疗方式时生存率有所提高。
