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背景与目的:老年急性髓性白血病(acutemyelogenousleukemia,AML)有独特的生物学及临床特征,患者对治疗的反应差、生存期短。本研究旨在探讨老年AML的预后因素。方法:对上海市第一人民医院1994～2005年收治的77例老年AML患者可能影响预后的因素进行Kaplan-Meier生存分析,然后对有意义的因素进行Cox比例风险模型分析。结果:可评价患者72例。年龄60～70岁者中位生存期(350天)显著长于年龄>70岁者(60天)(P<0.001),CR率显著提高(71.4%vs.29.4%,P=0.001);生存状态(performancestatus,PS)0或1分者中位生存期(402天)显著长于2、3、4分者(31天)(P<0.001),CR率显著提高(75.0%vs.15.0%,P<0.001);原发者中位生存期(98天)显著长于继发者(32天)(P=0.007),CR率显著提高(50.0%vs.0%,P=0.023);使用亚标准剂量的蒽环类药物者中位生存期(293天)显著长于减量使用者(35天)(P=0.006),CR率显著提高(63.6%vs.33.3%,P=0.02)。骨髓原始细胞(bonemarrowblastcell,BMblast)比率≤50%者中位生存期(98天)显著长于>50%者(55天)(P=0.006);预后良好核型者中位生存期(293天)显著长于预后不良或正常核型者(31天)(P=0.005);CD34阴性者中位生存期(201天)显著长于阳性者(36天)(P<0.001)。外周血白细胞数量(peripheralbloodwhitebloodcellcount,PBWBC)大于10×109/L者CR率(50.0%)显著高于PBWBC小于10×109/L者(25.0%)(P=0.043);化疗者CR率(50.0%)显著高于支持治疗者(0%)(P=0.001)。Cox比例风险模型分析显示影响生存期的7个因素均具有独立性和统计学意义。结论:年龄>70岁、PS为2～4分、骨髓原始细胞比率>50%、继发性、不良核型、CD34+以及蒽环类药物剂量强度是影响患者生存期的主要预后因素,蒽环类药物剂量显著影响CR率。
BACKGROUND & OBJECTIVE: AML has unique biological and clinical features. Patients with poor response to treatment and short survival period. This study aimed to investigate the prognostic factors of elderly AML. Methods: Kaplan-Meier survival analysis was performed on 77 prognosis factors of elderly AML patients admitted to Shanghai First People’s Hospital from 1994 to 2005. Cox proportional hazards model was then used to analyze the significant factors. Results: 72 evaluable patients. The median survival time (350 days) between the ages of 60 and 70 years was significantly longer than that of the patients aged> 70 years (60 days) (P <0.001). The CR rate was significantly higher (71.4% vs 29.4%, P = 0.001) (P <0.001). The median survival time (402 days) was significantly higher in patients with performancestatus PS than those with scores of 2, 3, and 4 (P <0.001) <0.001). The median survival time (98 days) was significantly longer in primary patients than in secondary ones (32 days) (P = 0.007), CR rate increased significantly (50.0% vs.0%, P = 0.023) The median survival of patients with anthracyclines (293 days) was significantly longer (35 days) (P = 0.006) and significantly higher CR rates (63.6% vs.33.3%, P = 0.02). Median survival (98 days) was significantly longer than> 50% (55 days) (P = 0.006); median survival in well-prognosis karyotypes (293 days) was lower than or equal to 50% for bone marrow blast cells (BMblast) (P = 0.005). The median survival time (201 days) in patients with CD34 negative was significantly longer than that in patients with positive (36 days) (P <0.001). The CR rate (50.0%) of peripheral blood white blood cell count (PBWBC)> 10 × 109 / L was significantly higher than that of PBWBC less than 10 × 109 / L (25.0%) (P = 0.043) ) Was significantly higher than that of supportive care (0%) (P = 0.001). Cox proportional hazards model analysis showed that the seven factors affecting survival were independent and statistically significant. CONCLUSIONS: Age> 70 years old, PS 2 to 4, bone marrow blasts ratio> 50%, secondary, adverse karyotype, CD34 + and anthracycline dose intensity are the main prognostic factors in patients’ survival. Anthracycline Class dose significantly affected CR rate.