Unidad de Investigación Médica en Epidemiologia Clínica, UMAE Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.
Servicio de Hematología Pediátrica, Hospital General "Gaudencio González Garza", Centro Médico Nacional "La Raza", IMSS, Mexico City, Mexico.
BMC Cancer. 2019 Jul 18;19(1):708. doi: 10.1186/s12885-019-5878-8.
Mexico City has one of the highest incidences and mortality rates of acute lymphoblastic leukemia (ALL) in the world and a high frequency of early relapses (17%) and early mortality (15%). Otherwise, childhood overweight and obesity are reaching epidemic proportions. They have been associated with poor outcomes in children with ALL. The aim of present study was to identify if overweight and obesity are predictors of early mortality and relapse in Mexican children with ALL.
A multicenter cohort study was conducted. ALL children younger than 15 years old were included and followed-up during the first 24 months after diagnosis. Overweight and obesity were classified according World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) criteria. Early mortality and early relapses were the main outcomes.
A total of 1070 children were analyzed. Overweight/obesity at diagnosis were predictors of early mortality (WHO: HR = 1.4, 95%CI:1.0-2.0; CDC: HR = 1.6, 95%CI:1.1-2.3). However, no associations between overweight (WHO: HR = 1.5, 95%CI:0.9-2.5; CDC: HR = 1.0; 95% CI:0.6-1.6) and obesity (WHO: HR = 1.5, 95%CI:0.7-3.2; CDC: HR = 1.4; 95%CI:0.9-2.3) with early relapse were observed.
Overweight and obese patients embody a subgroup with high risk of dying during leukemia treatment.
墨西哥城是世界上急性淋巴细胞白血病（ALL）发病率和死亡率最高的城市之一，早期复发率（17%）和早期死亡率（15%）都很高。此外，儿童超重和肥胖的发生率正呈流行趋势。这些问题与 ALL 患儿的不良预后有关。本研究旨在确定超重和肥胖是否可预测墨西哥 ALL 患儿的早期死亡和复发。
进行了一项多中心队列研究。纳入年龄小于 15 岁的 ALL 患儿，并在诊断后 24 个月内进行随访。根据世界卫生组织（WHO）和疾病控制与预防中心（CDC）的标准对超重和肥胖进行分类。早期死亡和早期复发是主要结局。
共分析了 1070 例患儿。诊断时超重/肥胖是早期死亡的预测因素（WHO：HR=1.4，95%CI：1.0-2.0；CDC：HR=1.6，95%CI：1.1-2.3）。然而，超重（WHO：HR=1.5，95%CI：0.9-2.5；CDC：HR=1.0；95%CI：0.6-1.6）和肥胖（WHO：HR=1.5，95%CI：0.7-3.2；CDC：HR=1.4；95%CI：0.9-2.3）与早期复发之间均无相关性。
超重和肥胖患者是白血病治疗过程中死亡风险较高的亚组。
