中文摘要：

目的研究老年急性髓系白血病（AML）的非遗传学预后因素。方法收集上海交通大学医学院附属瑞金医院血液科2007至2011年收治的年龄大于55岁的老年AML患者的临床资料，包括年龄、疾病分型、临床状态、白细胞计数（WBC）水平、乳酸脱氢酶（LDH）水平、白蛋白水平和治疗方案等。应用COX回归模型和Log—rank检验对上述因素与生存时间的关系进行单因素和多因素统计分析。结果M3亚型最具有生存优势。为了减少该亚型对预后分析的影响，对非M3型AML患者进行分析。单因素分析结果显示，患者年龄（P=0．003）、是否缓解（P〈0．01）、临床状态（P〈0．01）、其他器官疾病（P〈0．01）、WBC水平（P：0．022）、LDH水平（P=0．006）、白蛋白水平（P〈0．01）均与患者的生存时间相关。多因素分析结果显示，只有未达缓解（P〈0．01）、临床状态差（ECOG3～4）（P〈0．01）和高WBC水平（P〈0．01）是独立的预后不良因素。年龄≥70岁的患者，生存时间显著缩短。55—69岁的患者，生存时间无显著差异。对于年龄〈70岁的患者，DA／IA方案和CAG方案治疗均优于姑息治疗。对于年龄为70—80岁的患者，仅接受CAG方案的患者生存时间优于姑息治疗。对巩固方案对患者生存影响的研究显示，年龄〈70岁并获得缓解的患者，中剂量阿糖胞苷巩固治疗未显著延长患者的生存时间。结论老年AML患者与年轻患者不同，需要根据患者的临床具体情况进行分层治疗，中剂量阿糖胞苷巩固治疗可能不能改善老年患者的预后。

英文摘要：

Objective To analyze the prognostic factors in elderly patients with acute myeloid leuke- mia （AML）. Methods The clinical data of 211 AML patients with age 55 years or over and treated in Shanghai Jiaotong University Medical School affiliated Ruijin Hospital from 2007 to 2011 were collected and analyzed. Multivariate and univariate analysis of clinical data were performed using a Cox regression model and log-rank test, including age, subtype, performance status, white blood cell count, serum LDH and albu- min level, and treatment strategy. Results Acute promyelocytic leukemia （APL） patients had longer surviv- al than other subtypes. To rule out the impact of APL on the prognostic analysis, we conducted multivariate and univariate analysis excluding APL patients. The significant parameters of the univariate analysis were age （ P = 0.003 ） , achieving remission （ P 〈 0.01 ） , performance status （ P 〈 0. O1 ） , organ dysfunction （ P 〈 0.01 ） , increased WBC counts （ P = 0. 022 ） , increased LDH level （ P = 0. 006 ） and low albumin level （ P 〈 0.01 ）. Multivariate analysis showed that only failure of achieving remission （ P 〈 0.01 ） , poor performance status （ ECOG 3 - 4） （ P 〈 0.01 ） and increased WBC counts （ P 〈 0.01 ） were independent prognostic fac- tors. The patients aged 70 years or over had poor overall survival, and no significant difference of OS was ob- served among patients with age between 55 and 69 years. For patients aged 55 - 69 years received either DA/ IA or CAG treatments had longer survival than those with palliative treatments. For those aged 70 years or o- ver, only patients with CAG treatment had significantly longer survival than palliative treatment. For the pa- tients with age less than 70 years and achieving complete remission after induction, intermediate-dose cytara- bine consolidation might not improve survival. Conclusion Elderly AML patients should be treated indivi-dually. The imermediate-dose cy/aral）ine consolidatio