Kang Seungcheol, Im Ho Joon, Bae Kunhyung, Park Soo-Sung
Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Pediatrics, Division of Pediatric Hematology/Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
J Pediatr. 2017 Mar;182:290-295.e1. doi: 10.1016/j.jpeds.2016.11.072. Epub 2017 Jan 4.
To evaluate the clinical and prognostic impact of musculoskeletal manifestations as the only initial presenting symptom in childhood acute lymphoblastic leukemia (ALL).
We retrospectively reviewed 158 children with precursor B-cell type ALL who were followed up for >2 years. The patients were assigned to the groups musculoskeletal manifestations (n = 24) or nonmusculoskeletal manifestations (n = 134) based on initial presenting symptom. The symptom duration (regarding any initial presenting symptom) and the leukemic symptom duration (regarding symptoms of systemic manifestation, such as fever, bleeding, or pallor) were assessed, along with other clinical characteristics.
The musculoskeletal manifestations group exhibited a longer symptom duration than the nonmusculoskeletal manifestations group (43 days vs 22 days, P = .006), but overall survival did not significantly differ between the groups. Multivariate analysis indicated that a longer symptom duration did not affect prognosis but that a longer leukemic symptom duration was associated with a poorer prognosis (hazard ratio, 7.720; P = .048).
Musculoskeletal manifestations are associated significantly with diagnostic delay, but this delay does not affect the prognosis. Diagnostic delay after the onset of leukemic symptoms, however, does appear to affect the prognosis. Intensive evaluations for hematologic malignancies may be unnecessary in children who complain of limb pain without any definite cause, unless they also present with accompanying leukemic symptoms.
评估肌肉骨骼表现作为儿童急性淋巴细胞白血病（ALL）唯一初始症状时的临床及预后影响。
我们回顾性分析了158例前体B细胞型ALL患儿，其随访时间超过2年。根据初始症状将患者分为肌肉骨骼表现组（n = 24）和非肌肉骨骼表现组（n = 134）。评估了症状持续时间（针对任何初始症状）和白血病症状持续时间（针对全身表现症状，如发热、出血或苍白），以及其他临床特征。
肌肉骨骼表现组症状持续时间长于非肌肉骨骼表现组（43天对22天，P = .006），但两组总体生存率无显著差异。多因素分析表明，较长的症状持续时间不影响预后，但较长的白血病症状持续时间与较差的预后相关（风险比，7.720；P = .048）。
肌肉骨骼表现与诊断延迟显著相关，但这种延迟不影响预后。然而，白血病症状出现后的诊断延迟似乎确实会影响预后。对于无明确原因主诉肢体疼痛的儿童，除非同时伴有白血病症状，否则可能无需进行血液系统恶性肿瘤的强化评估。
