Racial and ethnic differences in survival of children with acute lymphoblastic leukemia
Racial and ethnic differences in survival of children with acute lymphoblastic leukemia
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DOI：
10.1182/blood-2002-02-0395
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发表时间：
2002-09-15
期刊：
影响因子：
20.3
通讯作者：
Robison, LL
中科院分区：
文献类型：
--
作者：
Bhatia, S;Sather, HN;Robison, LL
患有急性淋巴细胞白血病（ALL）的黑人儿童预后较差，但其他种族和民族背景（如西班牙裔和亚裔）儿童的相关信息有限。我们对接受儿童癌症组治疗方案治疗的ALL儿童进行了回顾性队列研究，以确定接受当代基于风险治疗的患者的种族和民族背景的结果。在1983年至1995年间，共有8447名新诊断为ALL的儿童（白人，n = 6703；西班牙裔，n = 1071；黑人，n = 506；亚洲人，n = 167）被观察，平均时间为6.5年。对疾病结局的分析以总生存期（OS）和无事件生存期（EFS）来衡量，并根据已知的结局预测因素进行调整，包括临床特征、疾病生物学、社会经济状况和治疗时间（1983-1989 vs 1989-1995）。不同种族患者生存率差异有统计学意义（P < 0.001）。5年EFS发生率分别为：亚洲75.1% +/- 3.5%；白色，72.8% +/- 0.6%；西班牙裔65.9% +/- 1.5%；黑色，61.5%±2.2%。多变量分析显示，与白人儿童相比，在调整了已知的风险因素后，黑人和西班牙裔儿童的预后较差，而亚洲儿童的预后较好。黑人儿童较差的预后在具有标准危险特征的患者中最为明显（相对危险度[RR]， 2.0； 95%置信区间[CI]， 1.6-2.5），而西班牙裔儿童较差的预后在具有高危特征的患者中最为明显（RR, 1.4; 95% Cl, 1.2-1.6）。在高危患者中，亚洲儿童的预后优于所有种族和族裔，特别是在最近的时代（5年EFS， 90.9% +/- 6.1%）。在接受当代基于风险的治疗的ALL儿童中，OS和EFS的种族和民族差异仍然存在。未来的研究应该关注这些差异的原因——可能是依从性或药物遗传学。
Black children with acute lymphoblastic leukemia (ALL) have poor outcomes, but limited information is available for children from other racial and ethnic backgrounds, such as Hispanic and Asian. We undertook a retrospective cohort study of children with ALL treated on Children's Cancer Group therapeutic protocols to determine outcomes by racial and ethnic backgrounds of patients treated with contemporary risk-based therapy. In total, 8447 children (white, n = 6703; Hispanic, n = 1071; black, n = 506; and Asian, n = 167) with newly diagnosed ALL between 1983 and 1995 were observed for a median of 6.5 years. Analysis of disease outcome was measured as overall survival (OS) and event-free survival (EFS) and was adjusted for known predictors of outcome including clinical features, disease biology, socioeconomic status, and treatment era (1983-1989 vs 1989-1995). There was a statistically significant difference in survival by ethnicity (P < .001). Five-year EFS rates were: Asian, 75.1% +/- 3.5%; white, 72.8% +/- 0.6%; Hispanic, 65.9% +/- 1.5%; and black, 61.5% +/- 2.2%. Multivariate analysis revealed that when compared with white children, black and Hispanic children had worse outcomes and Asian children had better outcomes after adjusting for known risk factors. The poorer outcomes among black children were most apparent among patients with standard-risk features (relative risk [RR], 2.0; 95% confidence interval [CI], 1.6-2.5), whereas poorer outcomes in Hispanic children (RR, 1.4; 95% Cl, 1.2-1.6) were most evident among patients with high-risk features. Asian children had better outcomes than all racial and ethnic groups among high-risk patients, particularly in the recent era (5-year EFS, 90.9% +/- 6.1%). Racial and ethnic differences in OS and EFS persist among children with ALL who receive contemporary risk-based therapy. Future studies should focus on reasons-perhaps compliance or pharmacogenetics for those differences.