1 University of California, Davis, CA.
2 Stanford University, Stanford, CA.
J Oncol Pract. 2019 Apr;15(4):e316-e327. doi: 10.1200/JOP.18.00264. Epub 2019 Mar 8.
Studies suggest that patients with acute lymphoblastic leukemia (ALL) have superior survival when treated at specialized cancer centers (SCCs). However, the association of early mortality (< 60 days) with location of initial care, sociodemographic factors, and complications has not been evaluated in pediatric and young adult (YA) patients with ALL.
Using the California Cancer Registry linked to hospitalization data, we identified pediatric and YA patients with ALL who received inpatient leukemia treatment between 1991 and 2014. Patients were classified as receiving all or part/none of their care at an SCC (Children's Oncology Group- or National Cancer Institute-designated cancer center). Propensity scores were created for treatment at an SCC in each age group. Multivariable, inverse probability-weighted Cox proportional hazards regression models identified factors associated with early mortality. Results are presented as hazard ratios (HRs) and 95% CIs.
Among 6,531 newly diagnosed pediatric (≤ 18 years) and YA (19 to 39 years of age) patients with ALL, 1.6% of children and 5.4% of YAs died within 60 days of diagnosis. Most children received all of their care at an SCC (n = 4,752; 85.7%) compared with 35.5% of YAs (n = 1,779). Early mortality rates were lower in pediatric patients and those receiving all care at an SCC (pediatric: all, 1.5%, v part/none, 2.4%; P = .049; YAs: all, 3.2%, v part/none, 6.6%; P = .001). However, in adjusted models, receiving all care at an SCC was associated with significantly lower early mortality in YAs (HR, 0.51; 95% CI, 0.32 to 0.81), but not in pediatric patients (HR, 0.77; 95% CI, 0.47 to 1.25).
YAs with ALL experience significant reductions in early mortality after treatment at SCCs.
研究表明，在专门的癌症中心（SCC）接受治疗的急性淋巴细胞白血病（ALL）患者的生存率更高。然而，儿科和年轻成人（YA）ALL 患者的早期死亡率（<60 天）与初始治疗地点、社会人口学因素和并发症之间的关联尚未得到评估。
我们使用加利福尼亚癌症登记处与住院数据相关联，确定了 1991 年至 2014 年间接受住院白血病治疗的儿科和 YA ALL 患者。患者分为在 SCC（儿童肿瘤学组或美国国家癌症研究所指定的癌症中心）接受全部或部分/无治疗的患者。在每个年龄组中为 SCC 治疗创建倾向评分。多变量、逆概率加权 Cox 比例风险回归模型确定了与早期死亡率相关的因素。结果以危险比（HR）和 95%CI 表示。
在 6531 名新诊断的儿科（≤18 岁）和 YA（19 至 39 岁）ALL 患者中，1.6%的儿童和 5.4%的 YA 在诊断后 60 天内死亡。大多数儿童（n=4752；85.7%）在 SCC 接受了全部治疗，而 YA 只有 35.5%（n=1779）。儿科患者和在 SCC 接受全部治疗的患者的早期死亡率较低（儿科：全部，1.5%，部分/无，2.4%；P=0.049；YA：全部，3.2%，部分/无，6.6%；P=0.001）。然而，在调整模型中，在 SCC 接受全部治疗与 YA 的早期死亡率显著降低相关（HR，0.51；95%CI，0.32 至 0.81），但在儿科患者中则不然（HR，0.77；95%CI，0.47 至 1.25）。
在 SCC 接受治疗的 YA ALL 患者的早期死亡率显著降低。
