Shuster J J, Wacker P, Pullen J, Humbert J, Land V J, Mahoney D H, Lauer S, Look A T, Borowitz M J, Carroll A J, Camitta B
Department of Pediatrics, University of Geneva, Switzerland.
J Clin Oncol. 1998 Aug;16(8):2854-63. doi: 10.1200/JCO.1998.16.8.2854.
In childhood B-precursor acute lymphoblastic leukemia (ALL), possible interactions among sex, time, and widely used prognostic factors (age, WBC count, and DNA index) were investigated for the first 5 years after diagnosis.
All eligible patients aged 1 to less than 22 years, registered between February 1986 and September 1994 in two B-precursor ALL studies from the Pediatric Oncology Group (POG), were included in the analysis. Cutpoints for age (3.0, 5.0, and 10.0 years), WBC count (10, 50, and 100 x 10(9)/L), and DNA index (DI; 1.16) were defined. Four time periods after diagnosis (years 1, 2, 3, and 4 and 5 combined) were selected for the study of prognostic significance over time. The cut-off date for analysis was April 1996.
A total of 3,717 children (2,010 boys and 1,707 girls) were included in the outcome analysis. No major differences between the sexes were observed in age, duration of symptoms before registration, WBC count, hemoglobin level, platelet count, ploidy, presence of CNS disease at diagnosis, or induction failure rate. Event-free survival (EFS) differences between sexes became significantly different from 2 years following diagnosis. At 5 years, in all subsets analyzed, boys fared worse than girls, although not all differences were statistically significant. Major sex differences in EFS were observed in older children (10 to 22 years), in patients with intermediate WBC counts (10 to 50 x 10(9)/ L), and in children who fit both of these subgroups, in whom the 2-year EFS was almost 20% higher in girls than in boys, reaching a 38% difference at 5 years.
This study shows an outcome interaction among sex, time, and commonly used prognostic variables. The important sex difference observed at 2 and 5 years suggests that more intensive consolidation and/or maintenance therapy in some boys with B-precursor ALL should be investigated.
在儿童B前体急性淋巴细胞白血病（ALL）中，对诊断后的前5年，研究性别、时间和广泛使用的预后因素（年龄、白细胞计数和DNA指数）之间可能存在的相互作用。
分析纳入了1986年2月至1994年9月期间在儿科肿瘤学组（POG）的两项B前体ALL研究中登记的所有符合条件的1至未满22岁患者。定义了年龄（3.0、5.0和10.0岁）、白细胞计数（10、50和100×10⁹/L）和DNA指数（DI；1.16）的切点。选择诊断后的四个时间段（第1、2、3年以及第4年和第5年合并）来研究随时间变化的预后意义。分析的截止日期为1996年4月。
共有3717名儿童（2010名男孩和1707名女孩）纳入结局分析。在年龄、登记前症状持续时间、白细胞计数、血红蛋白水平、血小板计数、倍性、诊断时中枢神经系统疾病的存在情况或诱导失败率方面，未观察到性别之间的重大差异。性别之间的无事件生存率（EFS）差异在诊断后2年开始变得显著不同。在5年时，在所有分析的亚组中，男孩的情况比女孩差，尽管并非所有差异都具有统计学意义。在年龄较大的儿童（10至22岁）、白细胞计数中等（10至50×10⁹/L）的患者以及符合这两个亚组条件的儿童中观察到EFS存在主要的性别差异，其中女孩的2年EFS比男孩高近20%，在5年时差异达到38%。
本研究显示了性别、时间和常用预后变量之间的结局相互作用。在2年和5年时观察到的重要性别差异表明，应对一些B前体ALL男孩进行更强化的巩固和/或维持治疗进行研究。
