从症状发作到诊断的时间间隔较长会影响急性淋巴细胞白血病患儿的总生存。
Longer Time Intervals From Symptom Onset to Diagnosis Affect the Overall Survival in Children With Acute Lymphoblastic Leukemia.
机构信息
Department of Laboratory Medicine, West China Second University Hospital, Sichuan University.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China.
出版信息
J Pediatr Hematol Oncol. 2022 Aug 1;44(6):285-292. doi: 10.1097/MPH.0000000000002344. Epub 2021 Oct 26.
BACKGROUND
Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Early diagnosis and timely treatment are essential for effective cancer control and have been widely analyzed in childhood cancer. However, few studies have described the time to diagnosis and treatment in children with ALL. This study investigated delays in diagnosis and treatment initiation and their impact on survival.
METHODS
This retrospective cohort study included 419 patients 0 to 14 years old at a tertiary hospital between 2011 and 2015. The optimal cutoff values for delays were determined by X-tile software. The Kaplan-Meier method and Cox regression models were used to evaluate the impact of delays on survival.
RESULTS
The median diagnosis, treatment, and total delays were 21 (interquartile range [IQR]: 11-35), 4 (IQR: 2-7), and 26 (IQR: 16-43) days, respectively. The results of multivariate analyses showed that diagnosis delay, risk stratification, and minimal residual disease level were independent predictors for treatment outcome in childhood ALL.
CONCLUSIONS
These findings suggested that a longer time to diagnosis negatively affected the clinical outcome of childhood ALL. Reducing the time to diagnosis could help to improve survival in these patients.
背景
急性淋巴细胞白血病（ALL）是儿童中最常见的癌症。早期诊断和及时治疗对于有效控制癌症至关重要，这在儿童癌症中已经得到了广泛分析。然而，很少有研究描述 ALL 患儿的诊断和治疗延迟情况。本研究旨在探讨诊断和治疗开始的延迟及其对生存的影响。
方法
这是一项回顾性队列研究，纳入了 2011 年至 2015 年在一家三级医院就诊的 419 名 0 至 14 岁的患儿。X-tile 软件确定了延迟的最佳截断值。采用 Kaplan-Meier 方法和 Cox 回归模型评估延迟对生存的影响。
结果
中位诊断、治疗和总延迟时间分别为 21（四分位距 [IQR]：11-35）、4（IQR：2-7）和 26（IQR：16-43）天。多变量分析结果表明，诊断延迟、危险分层和微小残留病水平是儿童 ALL 治疗结果的独立预测因素。
结论
这些发现表明，诊断时间延长会对儿童 ALL 的临床结局产生负面影响。缩短诊断时间可能有助于改善这些患者的生存。
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