Outcomes and Quality of Care in Acute Myeloid Leukemia Over 40 Years
Outcomes and Quality of Care in Acute Myeloid Leukemia Over 40 Years
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DOI：
10.1002/cncr.24373
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发表时间：
2009-07-01
期刊：
影响因子：
6.2
通讯作者：
Brandwein, Joseph
中科院分区：
文献类型：
--
作者：
Alibhai, Shabbir M. H.;Leach, Marc;Brandwein, Joseph
背景：急性髓细胞白血病（AML）预后不良，尤其是老年患者。据作者所知，迄今为止，几乎没有关于AML治疗模式和结局的基于人群的研究。方法：作者使用安大略癌症登记处来识别1965年至2003年间诊断为急性髓细胞白血病的所有患者。转诊到专门的癌症中心（SCC）和接受化疗作为护理质量指标进行了检查。在30天、1年和3年时，使用逻辑回归检查生存结局。结果：1965年至2003年，共有9365例患者（平均年龄58.1岁，范围0 - 103岁）发生AML。总体而言，75.1%、32.9%和17.3%的患者分别存活至30天、1年和3年。尽管19至59岁患者的生存率随时间推移而改善，但在老年患者中未观察到类似的改善。接受化疗的患者比例随着年龄的增长而下降（19-59岁患者中59.0% vs 29.3% vs >60岁）。与年轻患者相比，年龄>60岁的患者较少被转诊至SCC（20.8% vs 29.9%）。在多变量模型中，年龄较小、合并症较少、诊断年份较晚、接受化疗和转诊至SCC与较好的30天和长期生存率相关。结论：虽然随着时间的推移，年轻人的预后有所改善，但60岁以上的人仍然很差。与年轻患者相比，更少的老年患者被转诊到SCC或接受化疗，而这两个因素都与生存率的提高有关。可能存在改善老年AML患者护理质量和结局的机会。Cancer 2009;115：2903-11. (C)2009年美国癌症协会。
BACKGROUND: Acute myeloid leukemia (AML) is associated with a poor prognosis, particularly in older patients. To the authors' knowledge, few population-based studies of AML treatment patterns and outcomes exist to date. METHODS: The authors used the Ontario Cancer Registry to identify all patients diagnosed with AML between 1965 and 2003. Referral to specialized cancer centers (SCCs) and receipt of chemotherapy were examined as quality of care indicators. Survival outcomes were examined using logistic regression at 30 days, I year, and 3 years. RESULTS: A total of 9365 patients (mean age, 58.1 years; range, 0 to 103 years) developed AML between 1965 and 2003. Overall, 75.1%, 32.9%, and 17.3% of patients survived to 30 days, 1 year, and 3 years, respectively. Although survival improved over time among patients aged 19 to 59 years, similar improvements were not seen among older patients. The proportion of patients receiving chemotherapy declined with age (59.0% vs 29.3% among patients ages 19-59 vs >60 years). Fewer patients aged >60 years were referred to a SCC compared with younger patients (20.8% vs 29.9%). Younger age, less comorbidity, later year of diagnosis, receipt of chemotherapy, and being referred to a SCC were associated with better 30-day and long-term survival in multivariate models. CONCLUSIONS: Although the prognosis has improved over time among younger adults, it remains poor among those aged >60 years. Fewer older patients were referred to SCCs or treated with chemotherapy compared with younger patients, whereas both factors were associated with improved survival. Opportunities may exist to improve the quality of care and outcomes among older adults with AML. Cancer 2009;115:2903-11. (C) 2009 American Cancer Society.