| ObjectiveAcute myeloid leukemia(AML),defined as a malignant hematologic tumor caused by abnormal proliferation of immature medullary cells derived from bone marrow and peripheral blood,is one of the more common types of childhood acute leukemia,accounting for about one-fifth of childhood acute leukemia,with an increasing incidence and a high mortality rate.The 5-year overall survival(OS)and event-free survival(EFS)rates of childhood acute myeloid leukemia in China are only64%and 53%.The purpose of this study was to find out the main prognostic factors in children with acute myeloid leukemia,and to provide a reference for improving the treatment plan and prolonging the survival time of children.MethodThe medical records of children with acute myeloid leukemia admitted to a tertiary care hospital in Shenyang from January 1,2012 to December 31,2017 were collected,the study subjects were determined according to the inclusion and exclusion criteria,and the data were collected,collated and analyzed using Excel 2010 and SPSS22.0 software.Continuous variables that obey normal distribution are described by means and standard deviations,and data that do not obey normal distribution are described by medians and interquartile ranges;Kaplan-Meier method is used to draw survival curves and calculate cumulative survival rates;Log-Rank test is used to compare survival curves;multivariate analysis is performed using Cox proportional hazards regression model,with a test levelαof 0.05.ResultA total of 156 children under 16 years of age(including 16 years of age)with acute myeloid leukemia were included in this study.As of December 31,2020,85patients survived,62 died and 9 were lost to follow-up,with a follow-up rate of 5.77%;among them,94 were males and 62 were females,with a male to female ratio of 1.5:1;the minimum age of onset was 0 years and the maximum was 16 years,with an age of onset of 8.5 years;77 children achieved complete remission in the first course of treatment;38 children were M3 and 118 were non-M3,mainly non-M3 M2,accounting for 33.97%,followed by M5,accounting for 21.15%,1 child was M1 and M6,no children were M0,and the survival time of non-M3 was 49.1 months;the proportion of high-risk and low-risk children was 46.79%and 53.21%,respectively;the 1-5 survival rates were 80.91%,70.88%,63.45%,61.39%and 60.61%,respectively.The results of univariate analysis showed that complete remission in the first course,FAB classification,risk classification,white blood cell count,platelet count,immature cell percentage,fibrinogen content,thrombin coagulation time,and D-dimer content were prognostic factors for childhood acute myeloid leukemia(P<0.05);there was no significant difference in the survival rate between age,gender,different levels of neutrophil count,red blood cell count,hemoglobin content,prothrombin time,and hospitalization costs(P>0.05);age and neutrophil count were prognostic factors for M3childhood acute myeloid leukemia(P<0.05);white blood cell count,platelet count,and risk classification were prognostic factors for non-M3 childhood acute myeloid leukemia(P<0.05).The results of multivariate analysis showed that complete remission,platelet count,and risk classification in the first course of treatment were independent prognostic factors for childhood acute myeloid leukemia(P<0.05);there were no statistically significant influencing factors included in M3 children(P>0.05);platelet count and risk classification were independent prognostic factors for non-M3 childhood acute myeloid leukemia(P<0.05).ConclusionThe 1-,3-,and 5-year survival rates of children with acute myeloid leukemia were80.91%,63.45%,and 60.61%,respectively,and the survival time of children without M3 was 49.1 months;failure to achieve complete remission in the first course of treatment,platelet count<50×10~9/L at the first hospitalization,and high risk classification were risk factors affecting the prognosis of children with acute myeloid leukemia,M3 was a protective factor for the prognosis of children with acute myeloid leukemia;platelet count<50×10~9/L and high risk classification were risk factors affecting the prognosis of children with non-M3 acute myeloid leukemia. |
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