Huang Jing, Wang Leyan, Chen Lu, Qun He, Yajing Xu, Fangping Chen, Xielan Zhao
Xiangya Hospital, Central South University, Department of Hematology, Changsha, China Phone: +8673184896157 E-mail:
Turk J Haematol. 2017 Mar 1;34(1):10-15. doi: 10.4274/tjh.2016.0156. Epub 2016 Oct 18.
Previous studies compared the predictive ability of the European Treatment Outcome Study (EUTOS), Sokal, and Hasford scoring systems and demonstrated inconsistent findings with unknown reasons. This study was conducted to determine a useful scoring system to predict the prognosis of patients with chronic myeloid leukemia (CML) and identify the probable factors that affect the scoring.
This is a retrospective cohort study. The predictive ability of EUTOS and the factors that affect scoring were analyzed in 234 Chinese chronic-phase CML patients treated with frontline imatinib, including a few patients temporarily administered hydroxyurea for cytoreduction before imatinib. Patients were stratified into different risk groups according to each scoring system to assess the treatment outcomes and the predictive ability of EUTOS scores between patients who received imatinib during the entire follow-up period and patients who received altered treatment because of intolerance, progression, and treatment failure.
Sixty-one (26.0%) patients received altered treatments during the follow-up. In the EUTOS low- and high-risk groups, the 5-year overall survival was 94.6% and 84.7% (p=0.011), 5-year event-free survival was 92.6% and 77.6% (p=0.001), and 5-year progression-free survival (PFS) was 95.3% and 82.4% (p=0.001), respectively. The predictive ability of EUTOS was better than that of the Sokal and Hasford scores (p=0.256, p=0.062, p=0.073) without statistical significance. All three scoring systems were valid in predicting early optimal response. Kaplan-Meier analysis showed a high association between overall PFS and the EUTOS scores in the standard-dose imatinib group (p<0.001).
This study suggests that the EUTOS scoring system could predict the outcome of chronic-phase CML patients treated with standard-dose imatinib. Altered treatment is a crucial factor that affects the prognostic impact of EUTOS scoring. Achieving complete cytogenetic response at 18 months is an essential factor in predicting the prognosis of patients with CML.
既往研究比较了欧洲治疗结局研究（EUTOS）、索卡尔（Sokal）和哈斯福德（Hasford）评分系统的预测能力，但结果不一致，原因不明。本研究旨在确定一个有用的评分系统来预测慢性髓性白血病（CML）患者的预后，并识别影响评分的可能因素。
这是一项回顾性队列研究。分析了234例接受一线伊马替尼治疗的中国慢性期CML患者中EUTOS的预测能力及影响评分的因素，其中包括少数在伊马替尼治疗前临时使用羟基脲进行细胞减灭的患者。根据每个评分系统将患者分层为不同风险组，以评估治疗结局以及在整个随访期间接受伊马替尼治疗的患者与因不耐受、疾病进展和治疗失败而接受更改治疗的患者之间EUTOS评分的预测能力。
61例（26.0%）患者在随访期间接受了更改治疗。在EUTOS低风险组和高风险组中，5年总生存率分别为94.6%和84.7%（p = 0.011），5年无事件生存率分别为92.6%和77.6%（p = 0.001），5年无进展生存率（PFS）分别为95.3%和82.4%（p = 0.001）。EUTOS的预测能力优于索卡尔和哈斯福德评分（p = 0.256、p = 0.062、p = 0.073），但无统计学意义。所有三种评分系统在预测早期最佳反应方面均有效。Kaplan-Meier分析显示，标准剂量伊马替尼组的总体PFS与EUTOS评分之间存在高度相关性（p < 0.001）。
本研究表明，EUTOS评分系统可预测接受标准剂量伊马替尼治疗的慢性期CML患者的结局。更改治疗是影响EUTOS评分预后影响的关键因素。18个月时实现完全细胞遗传学缓解是预测CML患者预后的重要因素。
