基于SEER数据库的慢性髓细胞白血病患者预后分析  

Prognosis analysis of patients with chronic myeloid leukemia based on SEER database

作　　者：李倩[1] 赵艾琳 牛挺[1] Li Qian;Zhao Ailin;Niu Ting(Department of Hematology,West China Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川大学华西医院血液内科,成都610041

出　　处：《国际输血及血液学杂志》2021年第6期496-504,共9页International Journal of Blood Transfusion and Hematology

基　　金：四川大学华西医院临床研究孵化项目(19HXFH030);四川大学华西医院学科卓越发展1.3.5工程项目(ZYJC21007);国家血液系统疾病临床医学研究中心转化研究课题(2021WWB03)。

摘　　要：目的基于美国国立癌症研究所的监测、流行病学和结果(SEER)数据库中慢性髓细胞白血病(CML)患者的资料,探讨影响CML患者的生存预后因素及全因死亡差异。方法选择SEER数据库收录中于2000-2017年诊断的18505例CML患者为研究对象。将其按照诊断时间,分为2000-2005年组(n=5255)、2006-2011年组(n=6031)和2012-2017年组(n=7219);按照患者的诊断年龄,分为15~44岁组(n=4733)、45~64岁组(n=7237)、65~74岁组(n=3572)和75~84岁组(n=2963)。采用SEER*Stat 8.3.9软件提取患者的诊断时间、性别、种族、年龄、生存结局、死亡原因、生存时间、调整后的家庭年中位收入、居住地等基本信息。患者性别、诊断年龄、人种构成比等计数资料的组间比较,采用χ^(2)检验。采用Kaplan-Meier法分别绘制不同年龄组及不同诊断时间组患者的总体生存(OS)曲线,各组总体比较采用log-rank检验,组间两两比较采用Bonferroni法对P值进行校正。采用Cox比例风险回归模型对影响患者OS率的因素进行单因素及多因素分析。本研究遵循的程序符合2013年修订版《世界医学协会赫尔辛基宣言》要求。结果①本研究3组不同诊断时间组CML患者的一般资料比较结果显示,其诊断年龄、人种、调整后家庭中位年收入及居住地构成比分别比较,差异均有统计学意义(χ^(2)=108.035、38.721、274.437、28.377,P<0.001、<0.001、<0.001、=0.002);仅性别构成比比较,差异无统计学差异(P>0.05)。②对本研究18505例CML患者的中位随访时间为7.1年(3.3~11.7年),中位OS期为13.4年(未达到~3.8年),5年OS率为70.9%。随着CML患者诊断年龄的增加,其OS率降低,并且差异有统计学意义(4组总体比较:χ^(2)=4765.639,P<0.001;任意2组比较,P<0.008)。随着患者诊断时间的推后,其OS率升高,并且差异亦有统计学意义(3组总体比较:χ^(2)=273.461,P<0.001;任意2组比较:P<0.017)。③对可能影响本研究CML患者OS率的因素进行Objective To explore factors affecting prognosis of patients with chronic myeloid leukemia(CML)and differences in all-cause deaths based on case data of the surveillance,epidemiology,and end results(SEER)database.Methods A total of 18505 CML patients who were diagnosed from 2000 to 2017 and included in the SEER database were selected as research subjects.They were divided into 3 groups according to their diagnosis time:2000-2005 group(n=5255),2006-2011 group(n=6031)and 2012-2017 group(n=7219).Mereover,according to their diagnosis age,they were also divided into:15-44 years old group(n=4733),45-64 years old group(n=7237),65-74 years old group(n=3572)and 75-84 years old group(n=2963).Patients′basic data,such as diagnosis time,gender,race,age,survival outcome,cause of death,survival time,adjusted median annual household income and living region were extracted with SEER*Stat 8.3.9 software.Enumeration data such as composition ratios of gender,diagnosis age and race of patients among groups were compared with the Chi-square test.The Kaplan-Meier method was used to draw overall survival(OS)curves of patients among different age groups and different diagnosis year groups.The log-rank test was used for overall comparisons,and the Bonferroni method was used to adjust the P value for pairwise comparisons among groups.Univariate and multivariate analysis of factors influencing OS rate of patients were performed by Cox proportional hazards regression model.This study was in line with World Medical Association Declaration of Helsinki revised in 2013 and informed contents were obtained from the subjects.Results①Comparing general data of patients among 3 different diagnosis years groups,there was no statistical difference in gender composition ratio(P>0.005),but the differences in composition ratios of diagnosis age,race,adjusted median annual household income and living region were statistically significant(χ^(2)=108.035,38.721,274.437,28.377;P<0.001,<0.001,<0.001,=0.002).②The median follow-up time of 18505 CML patients

关 键 词：白血病 髓系 慢性 BCR-ABL阳性 蛋白酪氨酸激酶类 预后 死亡原因 酪氨酸激酶抑制剂 SEER数据库 

分 类 号：R733.72[医药卫生—肿瘤]