Department of Oncology, Karmanos Cancer Institute/Wayne State University School of Medicine, 4100 John R, HW04H0, Detroit, MI, 48201, USA.
Ann Hematol. 2023 May;102(5):1053-1062. doi: 10.1007/s00277-023-05154-0. Epub 2023 Mar 14.
There is a lack of contemporary population-based data on the epidemiology of acute promyelocytic leukemia (APL) in the United States. In this study, we aim to elucidate the demographics and early mortality patterns of APL hospitalizations utilizing the National Inpatient Sample database from 2016-2019. APL's annual age-adjusted incidence rate was 0.28/100,000, and the incidence increased with age, with the peak incidence in the 75-79 age group at 0.62/100,000. Whites constituted the majority of admissions at 67.7%, followed by Hispanics at 15.3%, the youngest racial group with a median age of 40 years. The median length of stay was 31 days for patients age < 60 years and 25 days for age ≥ 60 years (p < 0.001). After adjusting for confounders, the mean length of stay was 7 days higher in teaching hospitals compared to non-teaching hospitals (p 0.001). Overall mortality was 12.1% (22.2% for age ≥ 60 and 6.4% for < 60 years {p < 0.001}), and 56.5% of deaths happened before 7 days, with the median time to death being 6 days. The proportion of early deaths (< 7 days) in non-teaching hospitals was higher than late deaths (≥ 7 days) (19.2% vs. 5%; p 0.03), and admission to a teaching hospital was associated with lower mortality (adjusted odds ratio 0.27; p 0.01). Therefore, optimal treatment strategies need to be explored to mitigate this significant early mortality, especially in non-teaching hospitals.
美国目前缺乏关于急性早幼粒细胞白血病（APL）的当代基于人群的流行病学数据。在这项研究中，我们旨在利用 2016 年至 2019 年的国家住院患者样本数据库阐明 APL 住院患者的人口统计学和早期死亡率模式。APL 的年年龄调整发病率为 0.28/100,000，发病率随年龄增长而增加，75-79 岁年龄组的发病率峰值为 0.62/100,000。白人占住院患者的大多数，占 67.7%，其次是西班牙裔，占 15.3%，是年龄最小的种族群体，中位年龄为 40 岁。年龄<60 岁的患者中位住院时间为 31 天，年龄≥60 岁的患者为 25 天（p<0.001）。在调整混杂因素后，教学医院的平均住院时间比非教学医院长 7 天（p<0.001）。总死亡率为 12.1%（年龄≥60 岁的死亡率为 22.2%，年龄<60 岁的死亡率为 6.4%{p<0.001}），56.5%的死亡发生在 7 天之前，中位死亡时间为 6 天。非教学医院的早期死亡（<7 天）比例高于晚期死亡（≥7 天）（19.2%比 5%；p<0.03），入住教学医院与死亡率降低相关（调整后的优势比 0.27；p<0.01）。因此，需要探索优化治疗策略来减轻这种显著的早期死亡率，尤其是在非教学医院。
