A comparison of the effect of three different comorbidity indices on overall survival in patients with chronic myeloid leukemia.

IF 3.1 3区医学 Q2 HEMATOLOGY Therapeutic Advances in Hematology Pub Date : 2025-02-27 eCollection Date: 2025-01-01 DOI:10.1177/20406207251323701

Cumali Yalçın, Bedrettin Orhan, Ömer Candar, Sinem Çubukçu, Tuba Güllü Koca, Fazıl Çağrı Hunutlu, Şeyma Yavuz, Merve Nur Akyol, Tuba Ersal, Vildan Özkocaman, Fahir Özkalemkaş

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Abstract

Aims: It was aimed at measuring the comorbidities of chronic myeloid leukemia (CML) patients at the time of diagnosis with different comorbidity indices and evaluating their effects on disease prognosis.

Methods: The comorbidities of the patients were retrospectively screened and calculated in three different comorbidity indices: the ACE-27 Comorbidity Index, the Age-adjusted Charlson Comorbidity Index, and the Elixhauser Comorbidity Index. C-statistic was used to evaluate the ability of comorbidity indices to discriminate mortality. The relationship between the calculated scores and overall survival (OS) was evaluated with the Kaplan-Meier curve. Mortality risk was analyzed with a multivariate Cox regression model.

Results: A total of 218 CML patients were evaluated, and 211 chronic-phase patients were included in this study. The median age of the patients was 56 years (21-89), and 53% were female. As initial tyrosine kinase inhibitors, 201 (95%) patients were treated with imatinib, 10 (5%) patients with nilotinib. The median follow-up was 94.50 (9-201) months. The median OS was not reached. The most common comorbid conditions were hypertension 23% (n = 48), weight loss 19% (n = 40), diabetes mellitus 13% (n = 27), and cardiovascular disease 9% (n = 19). C-statistic values were 0.76 for ACE-27, 0.41 for ACCI, and 0.32 for ECI scores. In the Cox regression model including comorbidity scores, mortality risk was higher in patients with moderate ACE-27 score (HR: 148.05; 95% CI: 7.89-2751.53; p = 0.012), severe ACE-27 score (HR: 232.36; 95% CI: 14.20-4793.20; p = 0.001), ECOG 3 score (HR: 34.62; 95% CI: 2.67-447.36; p = 0.007), and high ELTS score (HR: 27.52; 95% CI: 1.34-543.68; p = 0.031).

Conclusion: This study showed that the ACE-27 Comorbidity Index is effective in predicting prognosis in CML patients. Therefore, comorbid conditions should be used more frequently as a prognostic marker at the time of diagnosis.

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三种不同合并症指标对慢性髓性白血病患者总生存期影响的比较。

目的：测定慢性髓性白血病（CML）患者在诊断时不同合并症指标的合并症情况，并评价其对疾病预后的影响。方法：采用ACE-27合并症指数、年龄校正Charlson合并症指数和Elixhauser合并症指数对患者的合并症进行回顾性筛选和计算。采用c统计量评价合并症指标区分死亡率的能力。采用Kaplan-Meier曲线评价计算得分与总生存期（OS）的关系。采用多变量Cox回归模型分析死亡风险。结果：共评估218例CML患者，其中211例为慢性期患者。患者年龄中位数为56岁（21-89岁），女性占53%。作为初始酪氨酸激酶抑制剂，201例（95%）患者使用伊马替尼，10例（5%）患者使用尼罗替尼。中位随访时间为94.50（9-201）个月。未达到中位操作系统。最常见的合并症是高血压23% (n = 48)，体重减轻19% (n = 40)，糖尿病13% (n = 27)，心血管疾病9% （n = 19）。ACE-27评分的c统计值为0.76，ACCI评分为0.41，ECI评分为0.32。在纳入合并症评分的Cox回归模型中，ACE-27评分中等的患者死亡风险更高(HR: 148.05；95% ci: 7.89-2751.53；p = 0.012)，重度ACE-27评分(HR: 232.36；95% ci: 14.20-4793.20；p = 0.001)， ECOG 3评分(HR: 34.62；95% ci: 2.67-447.36；p = 0.007)，且雅思成绩较高(HR: 27.52；95% ci: 1.34-543.68；p = 0.031)。结论：ACE-27合并症指数是预测CML患者预后的有效指标。因此，在诊断时应更频繁地将合并症作为预后指标。

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来源期刊

Therapeutic Advances in Hematology HEMATOLOGY-

CiteScore

4.30

自引率

0.00%

发文量

审稿时长

7 weeks

期刊介绍： Therapeutic Advances in Hematology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of hematology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in hematology, providing a forum in print and online for publishing the highest quality articles in this area.