Objective: To explore the prognostic significance of monosomal karyotype (MK) in patients with acute myeloid leukemia (AML).
Methods: The clinical data of 498 AML patients were analyzed retrospectively.
Results: Of the 498 patients, 233 (46.8%) cases had an abnormal karyotype. 42 patients fulfilled the criteria for MK, which were 8.4% of all cases and 18.0% of patients with abnormal karyotype, respectively. The most frequent autosomal monosomies were -7 and -17. 70 patients had complex karyotype (CK), in all patients and patients with abnormal karyotype accounted for 14.1% and 30.0%, respectively. Patients with MK were associated with significantly older (median age 62.5 vs 52 years, P=0.003), and lower HGB concentrations (62.5 vs 77 g/L, P=0.009) and lower WBC counts (7.0×10⁹/L vs 11.7×10⁹/L, P=0.008). Among MK cases, the most frequent chromosome abnormalities were complex karyotype, -7, -5, 7q-, and 5q-. In univariate analysis, MK patients had worse survival than those without MK (7.3 months vs 26.3 months, P<0.001). CK patients also had poorer outcomes than patients without CK (14.8 months vs 26.3 months, P<0.001). In CK patients, survival was worse in MK patients than patients without MK (7.4 months vs 19.2 months, P=0.007). By COX analysis, MK was an independent prognostic factor, beyond NCCN criteria and CK [HR=2.610 (1.632-4.175), P<0.001].
Conclusion: MK was an independent adverse prognostic factor in AML patients.
目的: 探讨单体核型（MK）在急性髓系白血病（AML）中的预后意义。
方法: 回顾性分析498例AML患者的临床资料并进行统计学分析。
结果: 498例AML患者中233例（46.8%）为异常核型，MK 42例，占全部患者的8.4％及异常核型的18.0%，最常见的为−7、−17。复杂核型（CK)70例，占全部患者的14.1％及异常核型的30.0%。与不伴有MK的AML患者比较，伴有MK者发病年龄较高（中位年龄62.5岁对52岁，P=0.003），外周血血红蛋白浓度较低（62.5 g/L对77 g/L，P=0.009），白细胞计数较低（7.0×109/L对11.7×109/L，P=0.008）。MK中常见的不良预后核型是复杂核型、−7、−5、7q−、5q−。单因素分析发现伴有MK的患者预后明显差于不伴有者（中位生存期分别为7.3和26.3个月，P<0.001)。伴有CK的患者预后亦差于不伴有者（中位生存期分别为14.8和26.3个月，P<0.001）。在伴有CK患者中，伴有MK的患者预后差于不伴有者（中位生存期分别为7.4和19.2个月，P=0.007）。COX回归风险模型分析显示MK是AML患者独立于NCCN预后分组和CK的预后因素(HR=2.610, 95%CI 1.632~4.175,P<0.001)。
结论: MK是AML患者独立的不良预后因素。