PDF(Pubmed)
Abstract：
BACKGROUND: It is important to understand the outcomes of adult acute lymphoblastic leukemia (ALL) patients at different facilities as treatment paradigms change.
OBJECTIVE: Our primary objective was to determine adult ALL overall survival (OS) by facility volume and type. Secondary objectives included identifying sociodemographic factors that may have impacted outcomes and analyzing treatment patterns by facility volume and type.
METHODS: This was a retrospective analysis of the National Cancer Database (NCDB) that included patients ≥40 years diagnosed with ALL between 2004 and 2016.
RESULTS: A total of 14 593 patients were included in this study. Univariate OS was greatest at low volume (LV) and community programs (CPs) and the least at high volume (HV) and academic programs (AP). This difference was lost after multivariable Cox proportional hazards model analysis, which found no difference in survival by facility volume or type, however, survival was significantly influenced by age, race, Hispanic ethnicity, insurance, and residence location (p < 0.05). Patients treated at HV and APs compared to LV and CP received more anti-neoplastic directed therapy.
CONCLUSIONS: Our results suggest treatment facility volume and type do not impact older adult ALL patient (≥40 years) survival, however confounding sociodemographic differences do impact survival outcomes, despite more aggressive and novel treatment approaches provided at HV and APs.
OBJECTIVE: Our primary objective was to determine adult ALL overall survival (OS) by facility volume and type. Secondary objectives included identifying sociodemographic factors that may have impacted outcomes and analyzing treatment patterns by facility volume and type.
METHODS: This was a retrospective analysis of the National Cancer Database (NCDB) that included patients ≥40 years diagnosed with ALL between 2004 and 2016.
RESULTS: A total of 14 593 patients were included in this study. Univariate OS was greatest at low volume (LV) and community programs (CPs) and the least at high volume (HV) and academic programs (AP). This difference was lost after multivariable Cox proportional hazards model analysis, which found no difference in survival by facility volume or type, however, survival was significantly influenced by age, race, Hispanic ethnicity, insurance, and residence location (p < 0.05). Patients treated at HV and APs compared to LV and CP received more anti-neoplastic directed therapy.
CONCLUSIONS: Our results suggest treatment facility volume and type do not impact older adult ALL patient (≥40 years) survival, however confounding sociodemographic differences do impact survival outcomes, despite more aggressive and novel treatment approaches provided at HV and APs.
摘要：
背景：了解成人急性淋巴细胞白血病（ALL）患者在不同治疗场所的转归是非常重要的。
目的：我们的主要目的是通过设施体积和类型确定成人ALL总生存期（OS）。次要目标包括确定可能影响结果的社会人口统计学因素，并按设施数量和类型分析治疗模式。
方法：这是对国家癌症数据库（NCDB）的回顾性分析，该数据库包括2004年至2016年间诊断为ALL的≥40岁患者。
结果：本研究共纳入14593例患者。单变量OS在低容量（LV）和社区计划（CP）中最大，而在高容量（HV）和学术计划（AP）中最小。在多变量Cox比例风险模型分析后，这种差异消失了，发现按设施数量或类型划分的存活率没有差异，然而,生存率受年龄的显著影响，种族,西班牙裔种族，保险,和居住地点(p<0.05)。与LV和CP相比，在HV和AP治疗的患者接受了更多的抗肿瘤定向治疗。
结论：我们的结果表明，治疗机构的体积和类型不会影响老年成年ALL患者（≥40岁）的生存率。然而，混杂的社会人口统计学差异确实会影响生存结果，尽管HV和AP提供了更积极和新颖的治疗方法。
目的：我们的主要目的是通过设施体积和类型确定成人ALL总生存期（OS）。次要目标包括确定可能影响结果的社会人口统计学因素，并按设施数量和类型分析治疗模式。
方法：这是对国家癌症数据库（NCDB）的回顾性分析，该数据库包括2004年至2016年间诊断为ALL的≥40岁患者。
结果：本研究共纳入14593例患者。单变量OS在低容量（LV）和社区计划（CP）中最大，而在高容量（HV）和学术计划（AP）中最小。在多变量Cox比例风险模型分析后，这种差异消失了，发现按设施数量或类型划分的存活率没有差异，然而,生存率受年龄的显著影响，种族,西班牙裔种族，保险,和居住地点(p<0.05)。与LV和CP相比，在HV和AP治疗的患者接受了更多的抗肿瘤定向治疗。
结论：我们的结果表明，治疗机构的体积和类型不会影响老年成年ALL患者（≥40岁）的生存率。然而，混杂的社会人口统计学差异确实会影响生存结果，尽管HV和AP提供了更积极和新颖的治疗方法。
