多发性骨髓瘤不同年龄层的患者生存和丧失生命年
2010-03-23 18:52:29   来源：丁香园   作者：  评论：0 点击：

目的：评估多发性骨髓瘤患者年龄对生存结果的影响并分析其特殊的损失寿命年。

病人和方法：对10549名患者进行评估；其中6996名患者接受常规化疗，而3553名患者则接受大剂量化疗后的自体干细胞移植。

结果：在所有研究对象中，平均和相对总生存时间分别为3.7和3.9年。实际生存时间逐渐从小于50岁患者的6.4年降低到80岁患者的2.5年。相对总生存时间同样有类似降低。年龄越大与国际分期系统（ISS）分期越高，两者有明显相关性。从40岁开始，每隔十年死亡风险就相对增加（P < .001， （50-59）岁v (40-49)岁；P < .001，（60- 69）岁 v （50-59）岁；P < .001 （70-79）岁 v （60-69）岁；且 P = .009 ， 80岁v （70-79）岁）。整个治疗组每例患者平均损失寿命年为16.8年，而且逐渐从小于40岁患者的36.1年降低到80岁患者的4.6年。

结论：年龄与较高的ISS分期有关，而且年龄是早期死亡率的重要危险因素。从50岁到80岁之间每隔十年生存时间呈逐年递减，从6年以上到不足3年。多发性骨髓瘤患者的平均损失寿命年高于其他类别的肿瘤并且在40岁以下的患者其平均损失寿命年大于30年，但是对于80岁或年龄更大者则不足5年。

附注;
Years of life are lost (YLL) take into account the age at which deaths occur by giving greater weight to deaths at younger age and lower weight to deaths at older age. The years of life lost (percentage of total) indicator measures the YLL due to a cause as a proportion of the total YLL lost in the population due to premature mortality.

Definition
YLL are calculated from the number of deaths multiplied by a standard life expectancy at the age at which death occurs. The standard life expectancy used for YLL at each age is the same for deaths in all regions of the world and is the same as that used for the calculation of Disability Adjusted Life Years (DALY).
Additionally 3% time discounting and non-uniform age weights which give less weight to years lived at young and older ages were used as for the DALY. With non-uniform age weights and 3% discounting, a death in infancy corresponds to 33 YLL, and deaths at ages 5 to 20 to around 36 YLL.

Associated terms
The Disability Adjusted Life Year or DALY is a health gap measure that extends the concept of potential years of life lost due to premature death (PYLL) to include equivalent years of ‘healthy’ life lost by virtue of being in states of poor health or disability (1). DALYs for a disease or health condition are calculated as the sum of the years of life lost due to premature mortality (YLL) in the population and the years lost due to disability (YLD) for incident cases of the health condition.

References

1.Lopez AD, Mathers CD, Ezzati M, Murray CJL, Jamison DT, 2006. Global burden of disease and risk factors. New York: Oxford University Press. (http://www.dcp2.org/pubs/GBD)

2.Mathers, C. D. Uncertainty and data availability for the Global Burden of Disease estimates
2000-2002. Evidence and Information for Policy Work ing Paper. 2005. Geneva, World Health Organization. (http://www.who.int/entity/healthinfo/publications/boduncertaintypaper2002.pdf)

3.Mathers CD, Ma Fat D, Inoue M, Rao C, Lopez AD. Counting the dead and what they died from: an assessment of the global status of cause of death data. Bulletin of the World Health Organization 2005;83(March):171-7(http://whqlibdoc.who.int/bulletin/2005/Vol83 -No3/bulletin_2005_83(3)_171-177.pdf)