CAJ | 학술논문

目的探讨造血干细胞移植共患病指数(HCT-CI)对异基因造血干细胞移植(allo-HSCT)患者移植后非复发死亡率(NRM)及总生存(OS)率的预测作用.方法选取2003年7月至2010年11月allo-HSCT患者161例纳入研究队列随访并总结临床资料,多因素分析HCT-CI、患者年龄、性别、预处理方案、移植前疾病状态、移植方式、HLA配型对NRM及OS率的影响.分析在不同移植前疾病状态下,HCT-CI评分对OS率及NRM的预测作用.结果 161例allo-HSCT患者3年OS率及NRM分别为61.4％及26.4％.HCT-CI评分0分、1～2分及≥3分组患者的3年NRM分别为14.9％、24.5％、52.7％,3年OS率分别为68.9％、64.6％、34.7％.组间比较显示,HCT-CI评分≥3分和0分组患者的3年NRM及OS率差异有统计学意义(P值均＜0.01).COX回归模型分析显示,移植前疾病状态高危、HCT-CI评分≥3为影响OS率及NRM的独立危险因素(相对危险度分别为3.53和3.35,3.77和6.85,P值均＜ 0.01).在移植前疾病状态为低危的101例患者中,HCT-CI评分为0分、1～2分和≥3分组患者的3年NRM及OS率差异有统计学意义(P值均＜0.01)；而在高危组的60例患者中,不同HCT-CI评分组间OS率及NRM的差异无统计学意义(P=0.252及0.347).结论 HCT-CI评分及移植前疾病状态分层是影响allo-HSCT后NRM和OS率的独立危险因素.在移植前疾病状态低危组,HCT-CI评分对allo-HSCT移植后的NRM及OS率具有预测作用；在移植前疾病状态高危组,HCT-CI评分对NRM及OS率无预测作用.
목적 탐토조혈간세포이식공환병지수(HCT-CI)대이기인조혈간세포이식(allo-HSCT)환자이식후비복발사망솔(NRM)급총생존(OS)솔적예측작용.방법 선취2003년7월지2010년11월allo-HSCT환자161례납입연구대렬수방병총결림상자료,다인소분석HCT-CI、환자년령、성별、예처리방안、이식전질병상태、이식방식、HLA배형대NRM급OS솔적영향.분석재불동이식전질병상태하,HCT-CI평분대OS솔급NRM적예측작용.결과 161례allo-HSCT환자3년OS솔급NRM분별위61.4％급26.4％.HCT-CI평분0분、1～2분급≥3분조환자적3년NRM분별위14.9％、24.5％、52.7％,3년OS솔분별위68.9％、64.6％、34.7％.조간비교현시,HCT-CI평분≥3분화0분조환자적3년NRM급OS솔차이유통계학의의(P치균＜0.01).COX회귀모형분석현시,이식전질병상태고위、HCT-CI평분≥3위영향OS솔급NRM적독립위험인소(상대위험도분별위3.53화3.35,3.77화6.85,P치균＜ 0.01).재이식전질병상태위저위적101례환자중,HCT-CI평분위0분、1～2분화≥3분조환자적3년NRM급OS솔차이유통계학의의(P치균＜0.01)；이재고위조적60례환자중,불동HCT-CI평분조간OS솔급NRM적차이무통계학의의(P=0.252급0.347).결론 HCT-CI평분급이식전질병상태분층시영향allo-HSCT후NRM화OS솔적독립위험인소.재이식전질병상태저위조,HCT-CI평분대allo-HSCT이식후적NRM급OS솔구유예측작용；재이식전질병상태고위조,HCT-CI평분대NRM급OS솔무예측작용.
Objective To study the prognostic implications of hematopoietic cell transplantationspecific comorbidity index (HCT-CI) on non-relapse mortality (NRM) and overall survival (OS) in patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods Clinical data of 161 cases received allo-HSCT from July 2003 to November 2010 were analyzed retrospectively.The prognostic significance of HCT-CI,age,sex,conditioning regimens,disease status before transplantation,graft source and the degree of HLA matches for NRM and OS was conducted by COX regression model.The prognostic impact of HCT-CI on NRM and OS was performed in all patients under different disease status before transplantation.Results Of the 16I cases with allo-HSCT,3-year NRM and OS were 26.4％ and 61.4％ respectively.NRM at 3 years in patients with HCT-CI score 0,1-2 and ≥3were 14.9％,24.5％ and 52.7％ respectively.And OS at 3 years were 68.9％,64.6％ and 34.7％respectively.There were significant differences between HCT-CI score 0 and ≥3 groups for NRM and OS (P＜0.01).High-risk disease status before transplantation (NRM:RR=3.35,P＜0.01; OS:RR=3.53,P＜0.01) and HCT-CI score ≥3 (NRM:RR=6.85,P＜0.01 ; OS:RR=3.77,P＜0.01) were independent risk factors by COX regression model.In the subgroup analysis according to disease status,high score of HCTCI was associated with poor OS (P＜0.01) and high NRM (P＜0.01) in patients with low-risk,but not in those with high-risk disease status.Conclusions HCT-CI score and disease status before transplantation are independent risk factors for patients received allo-HSCT.HCT-CI score have prognostic implication for NRM and OS in patients with low-risk disease status,but not in high-risk group.