Millar Seán R, Mohamed Mohamed Bakri, Mykytiv Vitaliy, McMorrow Rose, Donnelly Conan, O'Leary Eamonn, Orfali Nina, Murphy Philip, Browne Paul V, Quinn John, O'Gorman Peter, Ryan Mary F, Clifford Ruth, Hassadi Ezzat El, O'Shea Derville, Gilligan Oonagh, Krawczyk Janusz, O'Dwyer Michael E, Szegezdi Eva, Cahill Mary R
School of Public Health, University College Cork, Cork, Ireland.
Haematology Department, Cork University Hospital, Cork, Ireland.
Ir J Med Sci. 2024 Dec;193(6):2615-2623. doi: 10.1007/s11845-024-03756-9. Epub 2024 Jul 20.
The Blood Cancer Network Ireland and National Cancer Registry Ireland worked to create an Enhanced Blood Cancer Outcomes Registry (EBCOR). Enhanced data in acute myeloid leukaemia (AML) included an extensive data dictionary, bespoke software and longitudinal follow-up.
To demonstrate the utility of the database, we applied the data to examine a clinically relevant question: Charlson comorbidity index (CCI) usefulness in predicting AML patients' survival.
A software designer and consultant haematologists in Cork University Hospital worked together to standardise a data dictionary, train registrars and populate a database. One hundred and forty-one AML patients underwent enhanced data registration. Comorbidities identified by chart review were used to examine the capability of the CCI and age at diagnosis to predict mortality using Kaplan-Meier curves, Cox regression and receiver operating characteristic curves.
In regression analysis, a dose-response relationship was observed; patients in the highest CCI tertile displayed a greater risk (HR = 4.90; 95% CI 2.79-8.63) of mortality compared to subjects in tertile 2 (HR = 2.74; 95% CI 1.64-4.57) and tertile 1 (reference). This relationship was attenuated in an analysis which adjusted for age at diagnosis. The area under the curve (AUC) for the CCI was 0.76 (95% CI 0.68-0.84) while the AUC for age at diagnosis was 0.84 (95% CI 0.78-0.90).
Results suggest that the CCI provides no additional prognostic information beyond that obtained from age alone at AML diagnosis and that an EBCOR can provide a rich database for cancer outcomes research, including predictive models and resource allocation.
爱尔兰血癌网络与爱尔兰国家癌症登记处合作创建了一个强化血癌结局登记处（EBCOR）。急性髓系白血病（AML）的强化数据包括一个广泛的数据字典、定制软件和纵向随访。
为证明该数据库的实用性，我们应用这些数据来研究一个临床相关问题：查尔森合并症指数（CCI）在预测AML患者生存方面的效用。
科克大学医院的一名软件设计师和血液学顾问共同努力，对数据字典进行标准化、培训登记员并填充数据库。141名AML患者进行了强化数据登记。通过病历审查确定的合并症用于使用Kaplan-Meier曲线、Cox回归和受试者工作特征曲线来检验CCI和诊断时年龄预测死亡率的能力。
在回归分析中，观察到一种剂量反应关系；与第二三分位数（HR = 2.74；95% CI 1.64 - 4.57）和第一三分位数（参照）的受试者相比，CCI最高三分位数的患者死亡风险更高（HR = 4.90；95% CI 2.79 - 8.63）。在对诊断时年龄进行调整的分析中，这种关系减弱。CCI的曲线下面积（AUC）为0.76（95% CI 0.68 - 0.84），而诊断时年龄的AUC为0.84（95% CI 0.78 - 0.90）。
结果表明，CCI在AML诊断时除了从年龄本身获得的信息外，没有提供额外的预后信息，并且EBCOR可以为癌症结局研究提供一个丰富的数据库，包括预测模型和资源分配。
