Guru Murthy Guru Subramanian, Hamadani Mehdi, Dhakal Binod, Hari Parameswaran, Atallah Ehab
Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee WI, United States.
Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee WI, United States.
Leuk Res. 2018 Aug;71:95-99. doi: 10.1016/j.leukres.2018.07.013. Epub 2018 Jul 23.
Therapy related myeloid neoplasm (t-MN) is an emerging challenge in the current era. However, real world data on its incidence and survival at the population level remains sparse.
Using Surveillance Epidemiology and End Results (SEER-18) database, we identified patients aged ≥20 years with pathologically confirmed t-MN diagnosed between the years 2001-2014 and actively followed. Incidence rate per 100,000 population and incidence rate ratio (IRR) were calculated. Overall survival (OS) was calculated by Kaplan-Meier method with determinants analyzed by Cox proportional hazard regression method.
A total of 1093 patients with a median age of 65 years were identified. Overall incidence of t-MN was 0.13 cases/100,000 population and showed significant variations with age, race and the period of diagnosis. Two year OS significantly declined with increasing age (51.3% in age group 20-39, 33.9% in age group 40-59, 19.3% in age group 60-79 and 0% in age ≥ 80, p < 0.01). OS has improved over period (year 2001-2007 - 22.1% vs. year 2008-2014 -26.9%, p = 0.01). On multivariate analysis, increasing age was associated with significantly higher mortality. Compared to the period 2001-2007, a significantly lower risk for mortality was seen in the period 2008-2014 (HR 0.73, CI 0.58-0.92, p < 0.01).
Incidence of t-MN has significantly increased in the last decade. Although OS at the population level is improving over time, outcomes of this disorder continue to remain poor, highlighting the need for novel therapies.
治疗相关髓系肿瘤（t-MN）是当前时代一个新出现的挑战。然而，关于其在人群水平上的发病率和生存率的真实世界数据仍然匮乏。
利用监测、流行病学和最终结果（SEER-18）数据库，我们确定了年龄≥20岁、在2001年至2014年期间经病理确诊为t-MN且处于积极随访中的患者。计算了每10万人的发病率和发病率比（IRR）。采用Kaplan-Meier方法计算总生存期（OS），并通过Cox比例风险回归方法分析相关因素。
共识别出1093例患者，中位年龄为65岁。t-MN的总体发病率为0.13例/10万人，且在年龄、种族和诊断时期方面存在显著差异。两年总生存期随年龄增长显著下降（20 - 39岁年龄组为51.3%，40 - 59岁年龄组为33.9%，60 - 79岁年龄组为19.3%，≥80岁年龄组为0%，p < 0.01）。总生存期在不同时期有所改善（2001 - 2007年为22.1%，2008 - 2014年为26.9%，p = 0.01）。多因素分析显示，年龄增加与显著更高的死亡率相关。与2001 - 2007年相比，2008 - 2014年的死亡风险显著降低（风险比0.73，置信区间0.58 - 0.92，p < 0.01）。
在过去十年中，t-MN的发病率显著增加。尽管人群水平的总生存期随时间推移有所改善，但这种疾病的预后仍然很差，这凸显了对新型疗法的需求。
