PO.PS01.10 · 人群科学

儿童急性淋巴细胞白血病（ALL）的邻里差异与治疗结局：来自REDIAL联盟的报告

Neighborhood disparities and treatment outcomes in pediatric acute lymphoblastic leukemia (ALL): A report from the REDIAL Consortium

编号 870 展板 16 时间 4/19 02:00–05:00 区域 Section 34 主讲 Rutu Rathod, MBBS;MPH;PhD

分会场 Survivorship Research

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作者与单位 Authors & Affiliations

Rutu Rathod¹, Amy E. Hughes², Pagna Sok³, Karen Rabin⁴, Sandi L. Pruitt⁵, Philip J. Lupo⁶, Michael E. Scheurer⁶, Jeremy M. Schraw⁷

¹Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR,²University of Texas Southwestern Medical Center, Dallas, TX,³Baylor College of Medicine, Houston, TX,⁴Pediatrics, University of California, San Francisco, CA,⁵UT Southwestern Medical Center, Dallas, TX,⁶Pediatrics, Emory University School of Medicine, Atlanta, GA,⁷Pediatrics, Baylor College of Medicine, Houston, TX

摘要 Abstract

中文摘要

引言——急性淋巴细胞白血病（ALL）是最常见的儿童癌症，在社会经济处境不利和西班牙裔儿童中存在持续的结局差异。诸如邻里社会经济地位（nSES）和居住于西班牙裔聚居区（Hispanic enclaves，具有文化独特性、西班牙裔居民高度集中、语言隔离家庭及族裔资源丰富的社区）等结构性因素可能影响癌症结局，但其对儿童ALL的影响仍不明确。我们研究了nSES和西班牙裔聚居区居住与ALL患儿治疗结局之间的关联。方法——减少急性白血病差异（REDIAL）联盟包括横跨德克萨斯州的六家儿童癌症中心。我们纳入了2005-2017年间确诊为ALL并在休斯顿、沃思堡和麦卡伦的中心接受治疗的儿童（0-24岁）。人口普查区的西班牙裔聚居区和nSES（Yost）指数根据美国人口普查和美国社区调查数据计算得出。我们将西班牙裔聚居区定义为处于最高五分位（Q5）或与Q5相邻且西班牙裔居民>250人的Q4人口普查区，将低nSES定义为处于全州分布最低两个五分位的人口普查区，使用患者确诊时的地址。结局包括诱导治疗结束（EOI）时微小残留病（MRD）阳性（≥0.01%）、复发、无事件生存期（EFS）和总生存期（OS）。采用logistic和Cox回归模型评估关联，并对性别、确诊年龄、种族/族裔、NCI风险组、ALL免疫表型、细胞遗传学亚型及治疗机构进行校正。结果——在1,348名患者中，41%居住于低nSES人口普查区，42%居住于西班牙裔聚居区；59%为西班牙裔，90%为B-ALL。EFS的中位随访时间为5.6年，OS为5.2年。在校正分析中，聚居区居住（aOR= 1.22；95% CI= 0.82, 1.80）和低nSES（aOR= 1.06；95% CI= 0.73, 1.55）均与EOI MRD阳性无关；复发（聚居区：aOR= 0.88；95% CI= 0.52, 1.49；低nSES：aOR= 1.04；95% CI= 0.66, 1.64）、EFS（聚居区：aHR= 0.81；95% CI= 0.52, 1.26；低nSES：aHR= 1.04；95% CI= 0.71, 1.54）和OS（聚居区：aHR= 1.07；95% CI= 0.59, 1.94；低nSES：aHR= 0.89，95% CI= 0.53, 1.51）也观察到类似的无关联结果。尽管未校正分析表明低nSES地区的5年EFS略差（81%对比85%，p=0.04），但这一差异在校正后减弱。结论——在这一大型、多中心、多样化的ALL患儿队列中，在考虑临床和细胞遗传学特征后，邻里社会经济劣势和西班牙裔聚居区居住与治疗结局无独立关联。未来的研究应探讨其他社会决定因素以及邻里环境对疾病特征、生存期和远期效应的影响。

查看英文原文 English abstract

Introduction- Acute lymphoblastic leukemia (ALL), the most common pediatric cancer, shows persistent outcomes disparities among socioeconomically disadvantaged and Hispanic children. Structural factors such as neighborhood socioeconomic status (nSES) and residence in Hispanic enclaves - culturally distinct neighborhoods with high concentrations of Hispanic residents, linguistically isolated households, and ethnic resources - may influence cancer outcomes, yet their impact on pediatric ALL remains unclear. We examined associations of nSES and Hispanic enclave residence with treatment outcomes in children with ALL. Methods- The REducing Disparities in Acute Leukemia (REDIAL) Consortium includes six pediatric cancer centers across Texas. We included children (0-24 years) diagnosed with ALL between 2005-2017 and treated at centers in Houston, Fort Worth, and McAllen. Census tract Hispanic enclave and nSES (Yost) indices were computed from U.S. Census and American Community Survey data. We defined Hispanic enclaves as tracts in the highest quintile (Q5) or Q4 adjacent to Q5 with >250 Hispanic residents, and low nSES as tracts in the lowest two quintiles of statewide distribution, using patient addresses at the time of diagnosis. Outcomes included end-of-induction (EOI) minimal residual disease (MRD) positivity (≥0.01%), relapse, event-free survival (EFS), and overall survival (OS). Associations were evaluated using logistic and Cox regression models adjusted for sex, age at diagnosis, race/ethnicity, NCI risk group, ALL immunophenotype, cytogenetic subtype, and treating institution. Results- Among 1,348 patients, 41% resided in low nSES tracts and 42% in Hispanic enclaves; 59% were Hispanic and 90% had B-ALL. Median follow-up was 5.6 years for EFS and 5.2 years for OS. In adjusted analyses, neither enclave residence (aOR= 1.22; 95% CI= 0.82, 1.80) nor low nSES (aOR= 1.06; 95% CI= 0.73, 1.55) were associated with EOI MRD positivity; similar null associations were observed for relapse (enclave: aOR= 0.88; 95% CI= 0.52, 1.49; low nSES: aOR= 1.04; 95% CI= 0.66, 1.64), EFS (enclave: aHR= 0.81; 95% CI= 0.52, 1.26; low nSES: aHR= 1.04; 95% CI= 0.71, 1.54), and OS (enclave: aHR= 1.07; 95% CI= 0.59, 1.94; low nSES: aHR= 0.89, 95% CI= 0.53, 1.51). Although unadjusted analyses indicated slightly poorer 5-year EFS for low nSES areas (81% vs. 85%, p=0.04), this difference attenuated after adjustment. Conclusions- In this large, multi-center, and diverse cohort of children with ALL, neighborhood socioeconomic disadvantage and residence in Hispanic enclaves were not independently associated with treatment outcomes after accounting for clinical and cytogenetic features. Future studies should examine other social determinants and the influence of neighborhood context on disease characteristics, survivorship, and late effects.

利益披露 Disclosure

R. Rathod, None.. A. E. Hughes, None.. K. Rabin, None. S. L. Pruitt, Pfizer Independent Contractor. Gilead Travel. P. J. Lupo, None.. M. E. Scheurer, None.. J. M. Schraw, None.

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