急性早幼粒细胞白血病170例长期生存分析.DOCVIP

临床医学论文-急性早幼粒细胞白血病170例长期生存分析 作者：李新，赵耀中，李增军，李云涛，李妍，万长春，李桥川，邓书会，杨仁池，韩明哲，邱录贵 【摘要】? 本研究探讨影响急性早幼粒细胞白血病（APL）患者长期生存的预后因素。在回顾性分析了1990年1月至2004年12月本院170例APL患者的临床资料后，应用Log-Rank检验和Cox回归模型对170例患者的性别、年龄、初诊时白细胞（WBC）计数、血清乳酸脱氢酶水平、诱导缓解方案、获得缓解时间、缓解后治疗方案、PML/RARα阳性率进行单因素和多因素综合分析。结果表明：170例患者中位随访36个月（6-185个月），5年预计总体生存率（OS）为（80.9±4.0）%，5年预计无复发生存率（RFS）为（71.0±4.0）%。23例患者于中位缓解后15个月（6-70个月）复发。单因素分析显示，初诊时WBC计数、诱导缓解方案、获得缓解时间、缓解后治疗方案、PML/RARα阳性率均为影响APL患者长期生存的主要因素；多因素分析显示，缓解后治疗方案是影响APL患者长期生存的重要的独立因素。结论：在APL患者获得完全缓解后，应用化疗+维甲酸+砷剂的缓解后治疗方案将显著延长患者的生存时间。 【关键词】? 急性早幼粒细胞白血病 　　Long-Term Survival Analysis in 170 Cases of Acute Promyelocytic Leukemia 　　Abstract??? This study was aimed to investigate various factors influencing long-term survival in patients with acute promyelocytic leukemia. A single institutional retrospective study with long-term follow-up was perfomed to better define the prognostic factors and a rationale for the use of ATRA，chemotherapy，and As2O3 in the treatment of newly diagnosed APL patients. Newly diagnosed patients with APL entering complete remission (CR) were followed up for 6 to 185 months (n = 170) from January 1990 to December 2004. Univariate and multivariate analysis of 8 potential factors influencing survival and prognosis were carried out with Log-Rank and Cox regression method，including sex，age，initial WBC count，the level of lactic hydrogenase (LDH)，first induction regimen，time from induction therapy to CR，post-remission therapy，negative or positive? rate of? PML-RAR alpha and follow-up of reverse transcription-polymerase chain reaction (RT-PCR). The results showed that the estimated 5-year overall survival (OS) and relapse-free survival (RFS) were 80.9%±4.0% and 71.0%±4.0% respectively. The? 23 patients relapsed at the median time of 15 months（6-70）after CR. Univariate analysis revealed? that initial WBC count，first induction regimen，time? from induction therapy to CR，type of post-remission therapy and persistent negative RT-PCR in remission were important prognostic fa