Linet Martha S, Curtis Rochelle E, Schonfeld Sara J, Vo Jacqueline B, Morton Lindsay M, Dores Graça M
Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive 7E, Rockville, MD 20850, USA.
U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Silver Spring, MD, USA.
EClinicalMedicine. 2024 Mar 16;71:102549. doi: 10.1016/j.eclinm.2024.102549. eCollection 2024 May.
Population-based survival studies of adult acute myeloid leukemia (AML) have not simultaneously evaluated age at diagnosis, race and ethnicity, sex, calendar period or AML subtypes/subgroups among chemotherapy-treated patients.
For 28,473 chemotherapy-treated AML patients diagnosed at ages ≥20 years in population-based cancer registry areas of the Surveillance, Epidemiology, and End Results Program (2001-2018, followed through 2019), we evaluated 1-month through 5-year relative survival (RS) and 95% confidence intervals (95% CI) using the actuarial method in the SEER∗Stat Survival Session and overall survival (OS) using multivariable Cox regression to estimate proportional hazard ratios (HR) and 95% CI.
RS decreased with increasing age (20-39, 40-59, 60-74, 75-84, ≥85 years) at AML diagnosis. RS declined substantially within the first month and, except for acute promyelocytic leukemia, decreasing patterns continued thereafter for core binding factor AML, AML with antecedent condition/therapy, and all other AML. For all ages, acute promyelocytic leukemia RS stabilized after the first year. For total AML the hazard of death was significantly increased for non-Hispanic (NH)-Black (HR = 1.18, 95% CI = 1.12-1.24) and NH-Pacific Islander patients (HR = 1.31, 95% CI = 1.11-1.55) compared with NH-White patients. In contrast, NH-Asian and Hispanic patients had similar OS to NH-White patients across all ages and most AML subgroups. Males had significantly inferior survival to females with some exceptions. Compared to 2001-2006, in 2013-2018 OS improved for all age and AML subgroups.
Chemotherapy-treated U.S. adults with AML have notable differences in survival by age, race and ethnicity, sex, calendar-year period, and AML subgroup. Despite survival gains over time, our findings highlight the need for improving early outcomes across all AML subgroups, older ages, and Black and Pacific Islander patients and long-term outcomes among most treated groups.
Intramural Research Program of the U.S. National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, and the U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology.
基于人群的成人急性髓系白血病（AML）生存研究尚未同时评估化疗患者的诊断年龄、种族和族裔、性别、日历时间或AML亚型/亚组。
对于监测、流行病学和最终结果计划基于人群的癌症登记地区（2001 - 2018年，随访至2019年）中诊断时年龄≥20岁的28473例接受化疗的AML患者，我们在SEER∗Stat生存模块中使用精算方法评估了1个月至5年的相对生存（RS）及95%置信区间（95%CI），并使用多变量Cox回归评估总生存（OS）以估计比例风险比（HR）及95%CI。
AML诊断时，RS随年龄（20 - 39岁、40 - 59岁、60 - 74岁、75 - 84岁、≥85岁）增长而降低。RS在第一个月内大幅下降，除急性早幼粒细胞白血病外，此后核心结合因子AML、有前驱疾病/治疗的AML及所有其他AML的下降模式持续。对于所有年龄组，急性早幼粒细胞白血病的RS在第一年之后趋于稳定。对于所有AML患者，与非西班牙裔（NH）白人患者相比，非西班牙裔（NH）黑人患者（HR = 1.18，95%CI = 1.12 - 1.24）和NH太平洋岛民患者（HR = 1.31，95%CI = 1.11 - 1.55）的死亡风险显著增加。相比之下，NH亚裔和西班牙裔患者在所有年龄组和大多数AML亚组中的OS与NH白人患者相似。男性的生存情况明显劣于女性，但有一些例外。与2001 - 2006年相比，2013 - 2018年所有年龄组和AML亚组的OS均有所改善。
接受化疗的美国成年AML患者在生存方面因年龄、种族和族裔、性别、日历年份及AML亚组存在显著差异。尽管随着时间推移生存率有所提高，但我们的研究结果凸显了改善所有AML亚组、老年患者以及黑人和太平洋岛民患者的早期结局以及大多数治疗组长期结局的必要性。
美国国立卫生研究院、国家癌症研究所、癌症流行病学和遗传学司的内部研究项目，以及美国食品药品监督管理局、药品评价和研究中心、监测与流行病学办公室。
