Ou Judy Y, Smits-Seemann Rochelle R, Kaul Sapna, Fluchel Mark N, Sweeney Carol, Kirchhoff Anne C
Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, United States; Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, UT 84113, United States.
Department of Institutional Research and Reporting, Salt Lake Community College, Salt Lake City, UT 84123, United States.
Cancer Epidemiol. 2017 Aug;49:216-224. doi: 10.1016/j.canep.2017.06.005. Epub 2017 Jul 19.
Acute Lymphoblastic Leukemia (ALL) has a high survival rate, but cancer-related late effects in the early post-treatment years need documentation. Hospitalizations are an indicator of the burden of late effects. We identify rates and risk factors for hospitalization from five to ten years after diagnosis for childhood and adolescent ALL survivors compared to siblings and a matched population sample.
176 ALL survivors were diagnosed at ≤22 years between 1998 and 2008 and treated at an Intermountain Healthcare facility. The Utah Population Database identified siblings, an age- and sex-matched sample of the Utah population, and statewide inpatient hospital discharges. Sex- and birth year-adjusted Poisson models with Generalized Estimating Equations and robust standard errors calculated rates and rate ratios. Cox proportional hazards models identified demographic and clinical risk factors for hospitalizations among survivors.
Hospitalization rates for survivors (Rate:3.76, 95% CI=2.22-6.36) were higher than siblings (Rate:2.69, 95% CI=1.01-7.18) and the population sample (Rate:1.87, 95% CI=1.13-3.09). Compared to siblings and population comparisons, rate ratios (RR) were significantly higher for survivors diagnosed between age 6 and 22 years (RR:2.87, 95% CI=1.03-7.97 vs siblings; RR:2.66, 95% CI=1.17-6.04 vs population comparisons). Rate ratios for diagnosis between 2004 and 2008 were significantly higher compared to the population sample (RR:4.29, 95% CI=1.49, 12.32), but not siblings (RR:2.73, 95% CI=0.54, 13.68). Survivors originally diagnosed with high-risk ALL did not have a significantly higher risk than siblings or population comparators. However, high-risk ALL survivors (Hazard ratio [HR]:3.36, 95% CI=1.33-8.45) and survivors diagnosed from 2004 to 2008 (HR:9.48, 95% CI=1.93-46.59) had the highest risk compared to their survivor counterparts.
Five to ten years after diagnosis is a sensitive time period for hospitalizations in the ALL population. Survivors of childhood ALL require better long-term surveillance.
急性淋巴细胞白血病（ALL）的生存率较高，但治疗后早期与癌症相关的迟发效应需要记录。住院情况是迟发效应负担的一个指标。我们确定了儿童和青少年ALL幸存者诊断后5至10年的住院率及危险因素，并与同胞和匹配的人群样本进行比较。
176名ALL幸存者于1998年至2008年间在22岁及以下被诊断，并在山间医疗保健机构接受治疗。犹他州人口数据库确定了同胞、犹他州人口中年龄和性别匹配的样本以及全州住院患者出院情况。使用广义估计方程和稳健标准误差的性别和出生年份调整泊松模型计算发病率和率比。Cox比例风险模型确定了幸存者中住院的人口统计学和临床危险因素。
幸存者的住院率（发病率：3.76，95%置信区间=2.22-6.36）高于同胞（发病率：2.69，95%置信区间=1.01-7.18）和人群样本（发病率：1.87，95%置信区间=1.13-3.09）。与同胞和人群比较相比，6至22岁诊断的幸存者的率比（RR）显著更高（与同胞相比：RR：2.87，95%置信区间=1.03-7.97；与人群比较相比：RR：2.66，95%置信区间=1.17-6.04）。2004年至2008年诊断的率比与人群样本相比显著更高（RR：4.29，95%置信区间=1.49，12.32），但与同胞相比则不然（RR：2.73，95%置信区间=0.54，13.68）。最初被诊断为高危ALL的幸存者与同胞或人群对照相比，风险没有显著更高。然而，与其他幸存者相比，高危ALL幸存者（风险比[HR]：3.36，95%置信区间=1.33-8.45）和2004年至2008年诊断的幸存者（HR：9.48，95%置信区间=1.93-46.59）的风险最高。
诊断后5至10年是ALL人群住院的敏感时期。儿童ALL幸存者需要更好的长期监测。
