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題名 | An analysis of risk factor and survival in childhood acute lymphoblastic leukemia=小兒急性淋巴性白血病之危險因子與存活分析 |
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作者 | 陳博文; |
期刊 | 中華民國小兒科醫學會雜誌 |
出版日期 | 19890900、19891000 |
卷期 | 30:5 民78.09-10 |
頁次 | 頁299-308 |
分類號 | 417.5515 |
語文 | eng |
關鍵詞 | 小兒急性淋巴性白血病; 危險因子; 存活分析; |
中文摘要 | 為了研究小兒急性淋巴性白血病之存活與預後因子,本文回溯並分析自民國七十一年一月至七十六年六月間在臺大醫院小兒科七十八例新診斷之個案。患童依其未治療前之白血球數目及診斷時年齡,分為“標準危險”與“高危險”羣兩組。骨髓緩解率在標準羣與高危險羣分別爲97%與 80%。兩年暨三年之零失敗存活率在標準危險羣分別為37%及24%,其平均追蹤數為16個月。於高危險羣其兩年暨三年存活率分別為11%及4%,平均追蹤數為5個月。以Fisher exact test分析,有三要素與緩解引導失敗呈強烈相關;分別為高白血球數,肝臟腫大,與巨大淋巴節。“零失敗”長期存活率之單變項統計分析顯示變數:高白血球數,腦髓膜白血病,巨大淋巴節、肝臟腫大,年齡小於兩歲及大於十歲與高血清乳酸脫氫酶;對其最終預後有明顯不良之影響。此外在存活統計分析上應以多變項分析來決定各預後因子之統合效應,以評估其相關重要性。依Cox回歸分析結果顯示高白血球數為唯一重要且可獨立預測預後之決斷因素。初步結果同時顯示未充足接受治療與早期復發之關係。加強教育修正家屬觀念以及改善抗癌治療療效確為未來努力之目標。 |
英文摘要 | To study the survival and prognostic factor of childhood acute lymphoblastic leukemia, 78 newly-diagnosed cases between January 1982 and June 1987 in National Taiwan University Hospital were reviewed and analyzed. They were stratified into two groups, i.e. standard-risk (SR) and high-risk (HR), according to their pre-treatment leukocyte count and age. Following induction therapy, 97% of the SR patients and 80% of the I-JR patients attained complete remission. In the SR group, the 2- and 3-year failure-free survival rates were 37% and 24%, with a median survival of 16 months. In the HR group, failure-free survival at the second and third year were 11% and 4%, respectively, with a median survival of 5.3 months. Three factors are strongly related to induction failure, i.e. high leukocyte counts (>50*10^9/1), massive hepatomegaly and large lymph nodes. Univariate analysis of failure-free survival showed six variables with significant detrimental effects on eventual outcomes, i.e. high leukocyte counts (>50*10^9/1), meningeal leukemia, marked lymphadenopathy, age younger than 2 years and older than 10 years, massive hepatomegaly (>6cm), and high LDH level (>800 u/I). However, statistical survival models should also determine the joint effects of the prognostic factors so that the relative. importance of each factor can be assessed. High initial leukocyte count, disclosed by multivariate analysis, was the single most important factor detrimental to the continuance of complete remission (P=0.0004). Preliminary results also revealed poor compliance and early relapse in this study. Possible causes of early failure are discussed. Conceptual education for family members, as well as management with effective cyroreductive therapies are urgently needed. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。