Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Cancer Med. 2023 Feb;12(3):2850-2860. doi: 10.1002/cam4.5188. Epub 2022 Sep 27.
Studies of the association between body mass index (BMI) at diagnosis and treatment outcome in children with acute lymphoblastic leukemia (ALL) have yielded inconsistent results. Hence, we conducted a retrospective study in a large cohort of Chinese children with ALL treated with contemporary protocols.
A total of 1437 children (62.1% male; median age at diagnosis 5.7 years, range: 2.3-16.3 years) were enrolled in two consecutive clinical trials at the Shanghai Children's Medical Center. The rates of overall survival, event-free survival, relapse, treatment-related mortality, and adverse events were compared among patients who were underweight (BMI < 5th percentile), at a healthy weight (5th to 85th percentile), overweight (>85th to <95th percentile), and obese (≥95th percentile).
At diagnosis, 91 (6.3%) patients were underweight, 1070 (74.5%) were at a healthy weight, 91 (6.3%) were overweight, and 185 (12.9%) were obese. No significant association was found between weight status and 5-year overall survival, event-free survival, or relapse in the overall cohort. When analyzed as a continuous variable, a higher BMI Z-score was associated with treatment-related mortality (hazard ratio 1.33 (95% confidence interval [CI], 1.05-1.68%), p = 0.02). The treatment-related mortality rate was higher in the overweight (5.5%, 95% CI 0.8-10.2%) and obese (3.2%, 95% CI 0.6-5.8%) groups compared with the underweight (0.0%) and healthy-weight groups (1.9%, 95% CI 1.1-2.7%; p = 0.04). Multivariable analysis showed that children who were overweight had a higher risk of treatment-related mortality (hazard ratio 3.8, 95% CI 1.3-11.4).
While body weight status was not associated with event-free survival or overall survival, overweight patients were at higher risk of treatment-related mortality.
研究儿童急性淋巴细胞白血病（ALL）诊断时的体重指数（BMI）与治疗结果之间的关系，研究结果并不一致。因此，我们在中国两个采用当代方案治疗 ALL 的大型队列中进行了回顾性研究。
共有 1437 名儿童（62.1%为男性；中位诊断年龄为 5.7 岁，范围：2.3-16.3 岁）入组上海儿童医学中心的两个连续临床试验。在这些患者中，比较体重不足（BMI＜第 5 百分位数）、健康体重（第 5 至 85 百分位数）、超重（＞第 85 至＜第 95 百分位数）和肥胖（≥第 95 百分位数）患者的总生存率、无事件生存率、复发率、治疗相关死亡率和不良事件发生率。
诊断时，91 名（6.3%）患者体重不足，1070 名（74.5%）患者健康体重，91 名（6.3%）患者超重，185 名（12.9%）患者肥胖。在整个队列中，体重状况与 5 年总生存率、无事件生存率或复发率均无显著相关性。当作为连续变量进行分析时，BMI Z 评分越高，与治疗相关死亡率相关（风险比 1.33（95%置信区间[CI]，1.05-1.68%），p=0.02）。超重（5.5%，95%CI 0.8-10.2%）和肥胖（3.2%，95%CI 0.6-5.8%）组的治疗相关死亡率高于体重不足（0.0%）和健康体重组（1.9%，95%CI 1.1-2.7%；p=0.04）。多变量分析显示，超重儿童治疗相关死亡率风险更高（风险比 3.8，95%CI 1.3-11.4）。
虽然体重状况与无事件生存率或总生存率无关，但超重患者治疗相关死亡率风险更高。
