PO.PS01.02 · 人群科学
毛细胞白血病的长期死亡率趋势：一项美国全面人群分析（1999-2023）
Long-term mortality trends in hairy cell leukemia: A comprehensive U.S. population analysis (1999-2023)
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
毛细胞白血病（HCL）是一种罕见的惰性B细胞肿瘤，在嘌呤类似物治疗后具有极佳的生存结局。然而，长期的全国性死亡率趋势仍报道不足。本研究旨在评估美国HCL相关死亡率的长期模式及时间变化。方法：我们分析了1999年至2023年CDC WONDER中HCL个体（ICD-10：C91.4）的死亡记录。计算每100,000人的年龄校正死亡率（AAMR），并按年龄、性别、种族、西班牙裔来源和死亡地点分层。Joinpoint回归（NCI Joinpoint v5.4.0，加权BIC）识别年度百分比变化（APC）和拐点及95%置信区间（CI）。结果：1999年至2023年间共发生4,496例HCL相关死亡。总体AAMR从1999年的0.056下降至2018年的0.040（APC：-2.21；95% CI：-6.37至-1.29），随后非显著性地增至2023年的0.043（APC：5.07；95% CI：-0.69至21.32）。在男性中，AAMR从1999年的0.10下降至2015年的0.07（APC：-2.22；95% CI：-2.99至-1.44），随后显著增至2023年的0.096（APC：2.23；95% CI：0.69至3.80）。女性表现出从0.02到0.012的持续下降（APC：-2.35；95% CI：-3.51至-1.18）。死亡率集中在≥65岁的成人，最高率见于≥75岁者（每100,000人0.41-1.24）。White个体的AAMR最高（0.061），其次是Black（0.020）和Asian或Pacific Islander（0.008）。非西班牙裔个体占死亡的96%。大多数死亡发生在住院机构（44%）或家中（26%）。结论：HCL相关死亡率下降了近二十年，但已开始趋于平稳，近期在男性中观察到上升。女性的持续下降与男性的死亡率上升形成对比，提示两组之间结局差异正在扩大。死亡率持续集中于老年成人，反映了年龄、合并疾病和治疗相关免疫抑制的影响。需要持续监测以理解驱动这些变化的因素，包括复发模式、治疗选择以及老龄化幸存者人群面临的挑战，从而维持进展并减少新出现的差异。
查看英文原文 English abstract
Hairy cell leukemia (HCL) is a rare indolent B-cell neoplasm with excellent survival outcomes following purine analog therapy. However, long-term national mortality trends remain underreported. This study aims to evaluate long-term patterns of HCL-related mortality and temporal changes in the United States. Methods:We analyzed CDC WONDER mortality records from 1999 to 2023 for individuals with HCL (ICD-10: C91.4). Age-adjusted mortality rates (AAMR) per 100,000 were calculated and stratified by age, sex, race, Hispanic origin, and place of death. Joinpoint regression (NCI Joinpoint v5.4.0, weighted BIC) identified annual percent changes (APC) and inflection points with 95% confidence intervals (CI). Results:A total of 4,496 HCL-related deaths occurred from 1999 to 2023. The overall AAMR declined from 0.056 in 1999 to 0.040 in 2018 (APC: -2.21; 95% CI: -6.37 to -1.29), followed by a nonsignificant increase to 0.043 in 2023 (APC: 5.07; 95% CI: -0.69 to 21.32). Among males, the AAMR decreased from 0.10 in 1999 to 0.07 in 2015 (APC: -2.22; 95% CI: -2.99 to -1.44), then significantly increased to 0.096 in 2023 (APC: 2.23; 95% CI: 0.69 to 3.80). Females demonstrated a continuous decline from 0.02 to 0.012 (APC: -2.35; 95% CI: -3.51 to -1.18). Mortality was concentrated in adults ≥65 years, with the highest rates in those ≥75 years (0.41-1.24 per 100,000). White individuals had the highest AAMR (0.061), followed by Black (0.020) and Asian or Pacific Islander (0.008). Non-Hispanic individuals accounted for 96% of deaths. Most deaths occurred in inpatient facilities (44%) or at home (26%). Conclusion: HCL-related mortality declined for nearly two decades but has begun to plateau, with a recent increase observed among males. Persistent declines among females contrast with increasing mortality in males, suggesting a widening difference in outcomes between the two groups. Mortality continues to be concentrated in older adults, reflecting the influence of age, comorbid illness, and treatment-related immunosuppression. Continued surveillance is needed to understand the factors driving these changes, including relapse patterns, treatment selection, and the challenges faced by an aging survivor population, to sustain progress and reduce emerging disparities.
利益披露 Disclosure
A. Z. Sorathia, None..
B. Aldroubi, None..
D. Patel, None..
S. S. Afridi, None..
M. Patrick, None.