Oguma S, Yoshida Y, Uchino H, Maekawa T
Cancer Res. 1986 Jul;46(7):3698-700.
The association between leukemic transformation and various features recorded at presentation in patients with refractory anemia with excess of blasts and with or without ringed sideroblasts was analyzed in 255 patients using the proportional hazard model. Features associated with higher transformation rates were: higher values of blasts in peripheral blood or bone marrow; serum haptoglobin; vitamin B12; megakaryocytes in bone marrow; morphological abnormalities in granulo- or megakaryocyte series; male sex; circulating megakaryocytes in peripheral blood; older age; and lower ringed sideroblast proportion. Multivariate analysis was also performed using the following predictor variables: presence or absence of refractory anemia with excess of blasts; sex; abnormal granules in granulocytes; age; and mononuclear large megakaryocytes. Patients were divided arbitrarily into low (hazard ratio, less than 0.45), intermediate (hazard ratio, 0.45-1.85) and high (hazard ratio, greater than 1.85) risk groups. The cumulative leukemia-free rates in the low and intermediate risk groups showed long plateau phases at 95 and 71%, respectively, while in the high risk group, the rate was 10% at 5 years. For clinical purposes, the low risk group should be considered to have nonpreleukemia and the high risk group to have preleukemia.
运用比例风险模型，对255例伴有原始细胞增多的难治性贫血患者（伴有或不伴有环形铁粒幼细胞）初诊时记录的白血病转化与各种特征之间的关联进行了分析。与较高转化率相关的特征包括：外周血或骨髓中原始细胞比例较高；血清结合珠蛋白；维生素B12；骨髓中的巨核细胞；粒细胞或巨核细胞系的形态学异常；男性；外周血中循环巨核细胞；年龄较大；以及较低的环形铁粒幼细胞比例。还使用以下预测变量进行了多因素分析：是否存在伴有原始细胞增多的难治性贫血；性别；粒细胞中的异常颗粒；年龄；以及单核大巨核细胞。患者被任意分为低风险组（风险比小于0.45）、中风险组（风险比为0.45 - 1.85）和高风险组（风险比大于1.85）。低风险组和中风险组的累积无白血病生存率分别在95%和71%时呈现出较长的平台期，而高风险组在5年时的生存率为10%。出于临床目的，低风险组应被视为非白血病前期，高风险组应被视为白血病前期。
