美国急性淋巴细胞白血病、急性髓细胞白血病和霍奇金淋巴瘤患儿、青少年及年轻成人患者生存情况中的种族差异。
Racial disparities in the survival of American children, adolescents, and young adults with acute lymphoblastic leukemia, acute myelogenous leukemia, and Hodgkin lymphoma.
作者信息
Kahn Justine M, Keegan Theresa H M, Tao Li, Abrahão Renata, Bleyer Archie, Viny Aaron D
机构信息
Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York, New York.
Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California.
出版信息
Cancer. 2016 Sep 1;122(17):2723-30. doi: 10.1002/cncr.30089. Epub 2016 Jun 10.
BACKGROUND
Race-based survival in children and adolescents with hematologic malignancies has been a national challenge for decades. Large-scale investigations of age- and race-based survival trends over time in these patients have not previously been reported. The objective of this study was to investigate whether race- and age-related differences in pediatric and adolescent and young adult (AYA) leukemia and lymphoma survival persist and to what extent these differences have changed over time.
METHODS
Using the Surveillance, Epidemiology, and End Results program, this study investigated the outcomes of black and white (1975-2012; n = 27,369) and white and Hispanic (1992-2012; n = 20,574) children (0-14 years old) and AYAs (15-39 years old) with acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), and Hodgkin lymphoma (HL). Estimates of 5- and 10-year relative survival were compared over time.
RESULTS
Trends showed a convergence of survival for white and black children with ALL but a divergence in survival for AYA patients. Hispanic children and AYAs both suffered inferior outcomes. Trends for AML revealed persistent survival differences between black and white children and suggested worsening disparities for AYAs. Survival trends in HL revealed sustained survival differences between black and white AYA patients, whereas no differences were found in Hispanic and white patient outcomes for AML or HL.
CONCLUSIONS
Although survival for children and AYAs with ALL, AML, and HL has improved over the past 4 decades, differences persist between black, white, and Hispanic children and AYAs; survival disparities between black and white children with ALL have been nearly eliminated. Strategies aimed at identifying causality and reducing disparities are warranted. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2723-2730. © 2016 American Cancer Society.
背景
几十年来，儿童和青少年血液系统恶性肿瘤患者基于种族的生存率一直是一项全国性挑战。此前尚未有关于这些患者随时间推移基于年龄和种族的生存趋势的大规模调查报道。本研究的目的是调查儿童、青少年及青年（AYA）白血病和淋巴瘤患者的种族和年龄相关生存差异是否持续存在，以及这些差异随时间发生了多大变化。
方法
本研究利用监测、流行病学和最终结果计划，调查了患有急性淋巴细胞白血病（ALL）、急性髓细胞白血病（AML）和霍奇金淋巴瘤（HL）的0至14岁儿童以及15至39岁AYA患者中黑人和白人（1975 - 2012年；n = 27,369）以及白人和西班牙裔（1992 - 2012年；n = 20,574）的预后情况。对5年和10年相对生存率的估计随时间进行了比较。
结果
趋势显示，患有ALL的白人和黑人儿童生存率趋同，但AYA患者生存率出现差异。西班牙裔儿童和AYA患者的预后均较差。AML的趋势显示，黑人和白人儿童的生存差异持续存在，且AYA患者的差异有加剧趋势。HL的生存趋势显示，黑人和白人AYA患者的生存差异持续存在，而西班牙裔和白人患者在AML或HL的预后方面未发现差异。
结论
尽管过去40年来患有ALL、AML和HL的儿童及AYA患者的生存率有所提高，但黑、白、西班牙裔儿童及AYA患者之间的差异仍然存在；患有ALL的黑人和白人儿童之间的生存差异已几乎消除。有必要采取旨在确定因果关系并减少差异的策略。癌症2016。©2016美国癌症协会。癌症2016；122：2723 - 2730。©2016美国癌症协会。
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