Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Foundation National Institute for Cancer Epidemiology and Registration (NICER) c/o University of Zurich, Switzerland.
Cancer Epidemiol. 2019 Apr;59:51-57. doi: 10.1016/j.canep.2019.01.003. Epub 2019 Jan 25.
Chronic myelomonocytic leukemia (CMML) is a rare hematopoietic malignancy. Treatment with hypomethylating agents (HMA) was introduced between 2004 and 2006 but its impact on population-based survival remains controversial. The aim of this study was to investigate epidemiological characteristics and survival before and after introduction of HMA treatment.
We performed a population-based analysis of CMML cases reported to the Cantonal Cancer Registries in Switzerland (SWISS) and the Surveillance, Epidemiology, and End Results (SEER) Program from the United States for 1999-2006 (before HMA) and 2007-2014 (after HMA). Time trends were compared for these two time periods.
423 and 4144 new CMML cases were reported to the SWISS and SEER registries, respectively. We observed an increasing proportion of older patients ≥75 years in the SWISS (50.3%-62.3%) compared to a decreasing one in the SEER population (59.1%-55.1%). Age standardized incidence-rates were similar and remained stable in both countries (0.32-0.38 per 100'000 py). Relative survival (RS) improved significantly in the SEER (3 years 27%-37%; 5 years 19%-23%; p < 0.001 for both) but remained stable in the SWISS population (3 years 48% to 40%; 5 years 34% to 26%; n.s. for both).
With the exception of opposing age-trends, epidemiologic characteristics are similar in both countries and comparable to other population-based registries. RS remains poor and different time trends of population-based survival cannot be faithfully explained by HMA but most likely by changes in diagnostic accuracy within prognostically distinct age-groups.
慢性髓单核细胞白血病（CMML）是一种罕见的血液恶性肿瘤。低甲基化剂（HMA）的治疗于 2004 年至 2006 年间引入，但它对基于人群的生存的影响仍存在争议。本研究旨在调查 HMA 治疗引入前后的流行病学特征和生存情况。
我们对瑞士（SWISS）的州癌症登记处和美国的监测、流行病学和最终结果（SEER）计划报告的 1999-2006 年（HMA 治疗前）和 2007-2014 年（HMA 治疗后）CMML 病例进行了基于人群的分析。比较了这两个时期的时间趋势。
SWISS 和 SEER 登记处分别报告了 423 例和 4144 例新的 CMML 病例。我们观察到，SWISS 中≥75 岁的老年患者比例增加（50.3%-62.3%），而 SEER 人群中这一比例下降（59.1%-55.1%）。两国的年龄标准化发病率相似且保持稳定（0.32-0.38/10 万py）。相对生存率（RS）在 SEER 中显著提高（3 年 27%-37%；5 年 19%-23%；两者均 < 0.001），但在 SWISS 人群中保持稳定（3 年 48%至 40%；5 年 34%至 26%；两者均无统计学意义）。
除了年龄趋势相反之外，两国的流行病学特征相似，与其他基于人群的登记处相似。RS 仍然很差，基于人群的生存的不同时间趋势不能用 HMA 来准确解释，而很可能是由于在预后不同的年龄组中诊断准确性的变化。
