Haupt R, Fears T R, Robison L L, Mills J L, Nicholson H S, Zeltzer L K, Meadows A T, Byrne J
Clinical Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md.
JAMA. 1994 Nov 9;272(18):1427-32.
To determine the impact of treatment on scholastic performance in the first cohort of survivors of childhood acute lymphoblastic leukemia who are old enough to have completed their educational experience.
Retrospective cohort study.
Twenty-three institutions in the Childrens Cancer Group.
A total of 593 adult survivors of childhood acute lymphoblastic leukemia and 409 sibling controls.
Enrollment in special programs, grades during high school, graduation from high school, college admission, and college graduation.
After diagnosis, survivors were more likely than their sibling controls to enter a special education (relative risk [RR] = 3.4; P < .01) or a learning disabled (RR = 3.6; P < .01) program, while just as likely to enter gifted and talented programs (RR = 1.0). The risk associated with special education and learning disabled programs increased with increasing dose of cranial radiotherapy. Despite these problems, survivors generally had the same probability as their siblings of finishing high school, entering college, and earning a bachelor's degree. However, survivors treated with 24 Gy and those diagnosed before 6 years of age were less likely to enter college (RR = 0.67 and 0.6, respectively; P < .01).
This large study demonstrates that childhood acute lymphoblastic leukemia survivors have a greater likelihood of being placed in special education or learning disabled programs than their siblings, but that most are able to overcome these problems. Dose of cranial radiotherapy and age at diagnosis are the most important education-related risk factors.
确定治疗对首批年龄足够大已完成学业的儿童急性淋巴细胞白血病幸存者学业成绩的影响。
回顾性队列研究。
儿童癌症研究组的23家机构。
共593名儿童急性淋巴细胞白血病成年幸存者和409名同胞对照者。
参加特殊项目、高中成绩、高中毕业、大学录取和大学毕业情况。
诊断后，幸存者比其同胞对照者更有可能进入特殊教育项目（相对危险度[RR]=3.4；P<.01）或学习障碍项目（RR=3.6；P<.01），而进入天才和有天赋项目的可能性相同（RR=1.0）。与特殊教育和学习障碍项目相关的风险随颅脑放疗剂量增加而增加。尽管存在这些问题，但幸存者完成高中学业、进入大学并获得学士学位的概率通常与其同胞相同。然而，接受24 Gy治疗的幸存者以及6岁前被诊断出的幸存者进入大学的可能性较小（RR分别为0.67和0.6；P<.01）。
这项大型研究表明，儿童急性淋巴细胞白血病幸存者比其同胞更有可能被安排进入特殊教育或学习障碍项目，但大多数人能够克服这些问题。颅脑放疗剂量和诊断时的年龄是最重要的与教育相关的危险因素。
