Analysis of gastrointestinal and hepatic chronic graft-versus-host [corrected] disease manifestations on major outcomes: a chronic graft-versus-host [corrected] disease consortium study.
Analysis of gastrointestinal and hepatic chronic graft-versus-host [corrected] disease manifestations on major outcomes: a chronic graft-versus-host [corrected] disease consortium study.
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DOI：
10.1016/j.bbmt.2013.02.001
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发表时间：
2013-05
影响因子：
4.3
通讯作者：
Lee, Stephanie J.
中科院分区：
文献类型：
--
作者：
Pidala, Joseph;Chai, Xiaoyu;Kurland, Brenda F.;Inamoto, Yoshihiro;Flowers, Mary E. D.;Palmer, Jeanne;Khera, Nandita;Jagasia, Madan;Cutler, Corey;Arora, Mukta;Vogelsang, Georgia;Lee, Stephanie J.
虽然数据支持重叠亚型慢性GVHD的不良预后，但胃肠道（GI）部位和肝脏受累类型的重要性尚不清楚。使用来自慢性GVHD联盟观察性队列研究的数据（n=567，共2115次就诊），我们检查了GI部位（食管、上消化道、下消化道）和肝脏类型（胆红素、碱性磷酸酶（AP）、丙氨酸转氨酶（ALT））受损伤是否与总生存期（OS）和非复发死亡率（NRM）、症状、生活质量（QOL）和功能状态测量相关。在仅利用入组就诊数据的多变量分析中，较低的GI累及（HR 1.67, p=0.05）和升高的胆红素（HR 2.46, p=0.001）与OS相关；两者都与NRM有关。在使用所有就诊（时间相关协变量）的多变量分析中，GI评分大于零（HR 1.69, p=0.02）和胆红素升高（HR 3.73, p<0.001）与OS相关；NRM的结果相似。任何食管受累和GI评分大于0与症状和生活质量相关，而胆红素升高与生活质量相关。我们没有发现一致的证据表明上消化道受累、AP、ALT或NIH肝脏评分增加了生存、总体症状负担或生活质量的预后价值。这些数据支持了慢性GVHD患者根据GI和肝脏受累程度的患者报告结果的重要差异，并确定了那些在任何时候胆红素升高或GI评分较高，或在队列登记时GI受累较低的患者，在当前治疗方法下死亡风险更高。
While data support adverse prognosis of overlap subtype of chronic GVHD, the importance of site of gastrointestinal (GI) and type of hepatic involvement is not known. Using data from the Chronic GVHD Consortium observational cohort study (n=567, total of 2115 visits), we examined whether the site of GI (esophageal, upper GI, lower GI) and type of hepatic (bilirubin, alkaline phosphatase (AP), alanine aminotransferase (ALT)) involvement are associated with overall survival (OS)and non-relapse mortality (NRM), symptoms, quality of life (QOL) and functional status measures. In multivariate analysis utilizing data from enrollment visits only, lower GI involvement (HR 1.67, p=0.05) and elevated bilirubin (HR 2.46, p=0.001) were associated with OS; both were also associated with NRM. In multivariable analysis using all visits (time-dependent covariates), GI score greater than zero (HR 1.69, p=0.02) and elevated bilirubin (HR 3.73, p<0.001) were associated with OS; results were similar for NRM. Any esophageal involvement and GI score greater than zero were associated with both symptoms and QOL while elevated bilirubin was associated with QOL. We found no consistent evidence that upper GI involvement, AP, ALT, or NIH liver score add prognostic value for survival, overall symptom burden, or quality of life. These data support important differences in patient-reported outcomes according to GI and hepatic involvement among chronic GVHD affected patients, and identify those with elevated bilirubin or higher GI score at any time, or lower GI involvement at cohort enrollment, as patients at greater risk for mortality under current treatment approaches.
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影响因子：
11.4
作者：
Cho, B-S;Min, C-K;Kim, C-C
通讯作者：
Kim, C-C
影响因子：
3
作者：
MCHORNEY, CA;WARE, JE;RACZEK, AE
通讯作者：
RACZEK, AE
DOI：
10.1053/bbmt.2002.v8.pm12234170
发表时间：
2002-01-01
影响因子：
4.3
作者：
Lee, SJ;Cook, EF;Antin, JH
通讯作者：
Antin, JH
影响因子：
6.5
作者：
Pidala J;Anasetti C;Jim H
通讯作者：
Jim H
影响因子：
20.3
作者：
Stewart, BL;Storer, B;Martin, PJ
通讯作者：
Martin, PJ