三种不同合并症指数对慢性髓性白血病患者总生存期影响的比较。
A comparison of the effect of three different comorbidity indices on overall survival in patients with chronic myeloid leukemia.
作者信息
Yalçın Cumali, Orhan Bedrettin, Candar Ömer, Çubukçu Sinem, Güllü Koca Tuba, Hunutlu Fazıl Çağrı, Yavuz Şeyma, Akyol Merve Nur, Ersal Tuba, Özkocaman Vildan, Özkalemkaş Fahir
机构信息
Clinic of Hematology, Kütahya City Hospital, Evliya Çelebi Mahallesi, Okmeydanı Caddesi, Kütahya 43020, Turkey.
Division of Hematology, Department of Internal Medicine, Uludag University Faculty of Medicine, Bursa, Turkey.
出版信息
Ther Adv Hematol. 2025 Feb 27;16:20406207251323701. doi: 10.1177/20406207251323701. eCollection 2025.
AIMS
It was aimed at measuring the comorbidities of chronic myeloid leukemia (CML) patients at the time of diagnosis with different comorbidity indices and evaluating their effects on disease prognosis.
METHODS
The comorbidities of the patients were retrospectively screened and calculated in three different comorbidity indices: the ACE-27 Comorbidity Index, the Age-adjusted Charlson Comorbidity Index, and the Elixhauser Comorbidity Index. -statistic was used to evaluate the ability of comorbidity indices to discriminate mortality. The relationship between the calculated scores and overall survival (OS) was evaluated with the Kaplan-Meier curve. Mortality risk was analyzed with a multivariate Cox regression model.
RESULTS
A total of 218 CML patients were evaluated, and 211 chronic-phase patients were included in this study. The median age of the patients was 56 years (21-89), and 53% were female. As initial tyrosine kinase inhibitors, 201 (95%) patients were treated with imatinib, 10 (5%) patients with nilotinib. The median follow-up was 94.50 (9-201) months. The median OS was not reached. The most common comorbid conditions were hypertension 23% ( = 48), weight loss 19% ( = 40), diabetes mellitus 13% ( = 27), and cardiovascular disease 9% ( = 19). -statistic values were 0.76 for ACE-27, 0.41 for ACCI, and 0.32 for ECI scores. In the Cox regression model including comorbidity scores, mortality risk was higher in patients with moderate ACE-27 score (HR: 148.05; 95% CI: 7.89-2751.53; = 0.012), severe ACE-27 score (HR: 232.36; 95% CI: 14.20-4793.20; = 0.001), ECOG 3 score (HR: 34.62; 95% CI: 2.67-447.36; = 0.007), and high ELTS score (HR: 27.52; 95% CI: 1.34-543.68; = 0.031).
CONCLUSION
This study showed that the ACE-27 Comorbidity Index is effective in predicting prognosis in CML patients. Therefore, comorbid conditions should be used more frequently as a prognostic marker at the time of diagnosis.
目的
旨在使用不同的合并症指数测量慢性髓性白血病（CML）患者诊断时的合并症，并评估其对疾病预后的影响。
方法
回顾性筛查患者的合并症，并使用三种不同的合并症指数进行计算：ACE-27合并症指数、年龄调整Charlson合并症指数和Elixhauser合并症指数。使用卡方检验评估合并症指数区分死亡率的能力。用Kaplan-Meier曲线评估计算得分与总生存期（OS）之间的关系。使用多变量Cox回归模型分析死亡风险。
结果
共评估了218例CML患者，本研究纳入了211例慢性期患者。患者的中位年龄为56岁（21-89岁），53%为女性。作为初始酪氨酸激酶抑制剂，201例（95%）患者接受伊马替尼治疗，10例（5%）患者接受尼洛替尼治疗。中位随访时间为94.50（9-201）个月。总生存期未达到中位值。最常见的合并症为高血压23%（n = 48）、体重减轻19%（n = 40）、糖尿病13%（n = 27）和心血管疾病9%（n = 19）。ACE-27的卡方检验值为0.76，ACCI为0.41，ECI评分为0.32。在包含合并症评分的Cox回归模型中，ACE-27评分为中度的患者死亡风险更高（HR：148.05；95%CI：7.89-2751.53；P = 0.012），ACE-27评分为重度的患者（HR：232.36；95%CI：14.20-4793.20；P = 0.001），ECOG 3评分（HR：34.62；95%CI：2.67-447.36；P = 0.007），以及ELTS评分高的患者（HR：27.52；95%CI：1.34-543.68；P = 0.031）。
结论
本研究表明，ACE-27合并症指数在预测CML患者预后方面有效。因此，合并症应更频繁地用作诊断时的预后标志物。
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