Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Center for Pediatric Oncology and Hematology, Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.
Eur J Pediatr. 2017 Oct;176(10):1329-1337. doi: 10.1007/s00431-017-2978-9. Epub 2017 Aug 15.
The reported treatment outcomes of children treated for cancer in Eastern European countries are inferior to those in Northern/Western Europe. We hypothesized that recent survival rates could be comparable to the current standards and performed a population-based analysis of treatment outcome of childhood acute myeloid leukemia (AML) in Lithuania, a small Eastern European country. Children < 18 years old who were treated for AML from 2000 to 2013 were included (n = 54). Estimates of 5-year event-free (EFS) and overall survival (OS) rates were analyzed. Comparing periods 2000-2006 (n = 32) and 2007-2013 (n = 22), the EFS improved from 31 to 63% (p = 0.04), and the OS improved from 31 to 72% (p = 0.02) because of reductions in toxicity-related mortality (42 vs. 15%, p = 0.08) and relapse (43 vs. 25%, p = 0.08). The most significant improvement was demonstrated in high-risk patients (OS improved from 26 to 75%, p = 0.02) who benefited from hematopoietic stem cell transplantation: the post-transplant EFS increased from 13 to 86% (p = 0.01).
The current survival rate of Lithuanian children treated for AML was comparable to the expected rate in other parts of Europe. What is Known: • In the last three decades, significant improvement has been achieved in treating childhood cancer, with an overall survival (OS) rate of > 80% in high-income countries. The difference in survival rates between Northern/Western and Eastern European countries as well as between high- and middle-/low-income countries is as much as 20%. Recently, the 5-year event-free survival rate of acute myeloid leukemia (AML) has reached > 60% in high-income countries. The survival rates for myeloproliferative diseases were the lowest in Eastern European countries. • The reported inferior survival rates were calculated based on outcome data of patients treated until 2007. The recent survival rates in Eastern European countries are unknown. What is New: • Being a small Eastern European country, Lithuania has experienced good economic growth during the last decade. We hypothesized that economic growth and gain of experience could result in better survival rates of children treated for cancer in our country in recent years. • A population-based analysis of treatment outcome of childhood AML treated in Lithuania in the recent years was performed for the first time. The survival rates of childhood AML in Lithuania are comparable to those of other high-income countries. Current survival rates of children treated for cancer in Eastern European countries could be comparable to the best current standards contributing to better European survival rates of childhood cancer in general.
东欧国家儿童癌症治疗的报告结果劣于北欧/西欧国家。我们假设最近的生存率可以与当前标准相媲美，并对立陶宛（一个东欧小国）儿童急性髓系白血病（AML）的治疗结果进行了一项基于人群的分析。纳入 2000 年至 2013 年间治疗 AML 的<18 岁儿童（n=54）。分析 5 年无事件生存率（EFS）和总生存率（OS）。比较 2000-2006 年（n=32）和 2007-2013 年（n=22）两个时期，EFS 从 31%提高到 63%（p=0.04），OS 从 31%提高到 72%（p=0.02），原因是毒性相关死亡率（42%比 15%，p=0.08）和复发率（43%比 25%，p=0.08）降低。高危患者的改善最为显著（OS 从 26%提高到 75%，p=0.02），他们受益于造血干细胞移植：移植后 EFS 从 13%增加到 86%（p=0.01）。
立陶宛儿童治疗 AML 的当前生存率与欧洲其他地区的预期生存率相当。
在过去三十年中，儿童癌症的治疗取得了显著进展，高收入国家的总生存率（OS）超过 80%。北欧/西欧国家与东欧国家以及高收入/中低收入国家之间的生存率差异高达 20%。最近，高收入国家急性髓系白血病（AML）的 5 年无事件生存率已达到>60%。东欧国家骨髓增生性疾病的生存率最低。
报告中较差的生存率是根据 2007 年前治疗的患者的结果数据计算得出的。东欧国家最近的生存率尚不清楚。
作为一个东欧小国，立陶宛在过去十年中经历了良好的经济增长。我们假设经济增长和经验的积累可能会导致近年来我国癌症患儿的生存率提高。
我们首次对近年来立陶宛儿童 AML 治疗的治疗结果进行了基于人群的分析。立陶宛儿童 AML 的生存率与其他高收入国家相当。东欧国家癌症患儿的当前生存率可能与当前最佳标准相当，有助于提高欧洲儿童癌症的总体生存率。
