儿童急性白血病的诊断:居住地偏远对诊断时间的影响

Q4 Medicine
M. Rykov, I. S. Dolgopolov
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The diagnoses were: ALL, C91.0 – 30 (86 %), AML , C92 – 3 (9 %), and AL of unspecified cell type (ALUCL ), C95.0 – 2 (5 %) patients. The mean age was 61 months. Thrombocytopenia and anemia at the time of diagnosis were found in 76 % and 78 %, respectively. Leukocytosis >20×109/L was observed in 58 %, leukopenia <3.5×109/L in 15 % of patients. In 97 % of cases, blasts (2 % to 95 %) were detected in peripheral blood. In the city of Tver (group 1) and the Tver region (group 2), 16 (46 %) and 19 (54 %) patients were identified, respectively. The mean age of patients in group 1 was 28.6 months and the mean age in group 2 was 72.3 months (p=0.1). Results. In group 1 and 2, ALL was diagnosed in 14 (88 %) and 16 (84 %), AML in 1 (6 %) and 2 (11 %) and ALUCL in 1 (6 %) and 1 (5 %) cases, p=0.6, 0.7 and 0.95, respectively. Delay in diagnosis in the general group (n=35) was observed <2 weeks in 21 (60 %) cases, 2–4 weeks – in 7 (20 %), ≥4–≤8 weeks – in 4 (11 %) and >8 weeks – in 3 (9 %) cases. Delayed diagnosis among patients living in the city of Tver and Tver region was observed <2 weeks in 7 (44 %) vs 13 (68 %) cases, 2–4 weeks – in 6 (38 %) vs 3 (17 %), ≥4–≤8 weeks – in 1 (6 %) vs 1 (5 %) and >8 weeks – in 2 (12 %) vs 2 (10 %) cases, respectively (p=0.37). There was no significant impact of the distance of the residence place from the level 3 children’s hospital providing specialized care (RCC H) on the time of diagnosis. With the removal of <50 km the diagnosis delay <2 weeks, 2–4 weeks, ≥4–≤8 weeks, >8 weeks was observed in 36, 36, 21 and 7 %, respectively. With the removal of ≥50–≤100 km, the diagnosis was made in the period of 2–4 weeks in 100 % of cases. With the removal of >100 km the diagnosis delay <2 weeks, 2–4 weeks, ≥4–≤8 weeks, >8 weeks was observed in 30, 30, 20 and 20 %, respectively (p=0.78). Conclusion. 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引用次数: 0

摘要

背景。急性白血病(AL)是最常见的儿童癌症,发病率约为每 100 万名 18 岁以下儿童中 55-62 例。急性白血病由于症状不具特异性而难以诊断,这些症状往往隐藏在其他疾病的 "面具 "之下。这一问题在人口不超过 10 万的地区尤为突出,因为这些地区的儿童每 2-5 年才被诊断出一次急性白血病,导致儿科医生对癌症的警觉性过低。目的:根据特维尔地区的居住区域和距离特维尔地区临床儿童医院(RCC H)的远近,评估诊断延迟的情况。材料与方法分析对象包括2018年至2023年期间在RCC H肿瘤血液科住院的35名患者。诊断为ALL, C91.0 - 30 (86 %),AML , C92 - 3 (9 %),AL of unspecified cell type (ALUCL ), C95.0 - 2 (5 %)患者。平均年龄为 61 个月。诊断时发现血小板减少和贫血的比例分别为 76% 和 78%。白细胞增多>20×109/L者占58%,白细胞减少8周者占3(9%)。居住在特维尔市和特维尔地区的患者中,分别有 2 例(12%)和 2 例(10%)延迟诊断 8 周(P=0.37)。居住地与提供专业治疗的三级儿童医院(RCC H)的距离对诊断时间没有明显影响。除去 8 周的时间,分别有 36%、36%、21% 和 7%。当行程≥50-≤100公里时,100%的病例在2-4周内得到诊断。当行程大于 100 公里时,分别有 30%、30%、20% 和 20% 的病例在 8 周后得到诊断(P=0.78)。结论通过每天与乡镇医院和门诊部召开在线会议,然后将疑似溶血性疾病的儿童迅速送往专业部门住院治疗,儿童 AL 的诊断时间不会受到距离三级医院远近的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diagnosis of acute leukemia in children: the impact of remote residence on the time to make a diagnosis
Background. Acute leukemia (AL) is the most common childhood cancer with an incidence rate of about 55–62 cases per 1 million children under 18 years of age. Acute leukemia is difficult to diagnose due to nonspecific symptoms, which are often hidden under the “masks” of other diseases. This problem is especially relevant for regions with a population of up to 100,000 people, where AL in children is diagnosed once every 2–5 years causing too low cancer alertness among pediatricians. Aim: to assess the delay in diagnosis depending on the areas of residence in the Tver region and area remoteness from the Tver Regional Clinical Children’s Hospital (RCC H). Material and Methods. The analysis included 35 patients hospitalized in the Department of Oncology and Hematology of the RCC H for the period from 2018 to 2023. The diagnoses were: ALL, C91.0 – 30 (86 %), AML , C92 – 3 (9 %), and AL of unspecified cell type (ALUCL ), C95.0 – 2 (5 %) patients. The mean age was 61 months. Thrombocytopenia and anemia at the time of diagnosis were found in 76 % and 78 %, respectively. Leukocytosis >20×109/L was observed in 58 %, leukopenia <3.5×109/L in 15 % of patients. In 97 % of cases, blasts (2 % to 95 %) were detected in peripheral blood. In the city of Tver (group 1) and the Tver region (group 2), 16 (46 %) and 19 (54 %) patients were identified, respectively. The mean age of patients in group 1 was 28.6 months and the mean age in group 2 was 72.3 months (p=0.1). Results. In group 1 and 2, ALL was diagnosed in 14 (88 %) and 16 (84 %), AML in 1 (6 %) and 2 (11 %) and ALUCL in 1 (6 %) and 1 (5 %) cases, p=0.6, 0.7 and 0.95, respectively. Delay in diagnosis in the general group (n=35) was observed <2 weeks in 21 (60 %) cases, 2–4 weeks – in 7 (20 %), ≥4–≤8 weeks – in 4 (11 %) and >8 weeks – in 3 (9 %) cases. Delayed diagnosis among patients living in the city of Tver and Tver region was observed <2 weeks in 7 (44 %) vs 13 (68 %) cases, 2–4 weeks – in 6 (38 %) vs 3 (17 %), ≥4–≤8 weeks – in 1 (6 %) vs 1 (5 %) and >8 weeks – in 2 (12 %) vs 2 (10 %) cases, respectively (p=0.37). There was no significant impact of the distance of the residence place from the level 3 children’s hospital providing specialized care (RCC H) on the time of diagnosis. With the removal of <50 km the diagnosis delay <2 weeks, 2–4 weeks, ≥4–≤8 weeks, >8 weeks was observed in 36, 36, 21 and 7 %, respectively. With the removal of ≥50–≤100 km, the diagnosis was made in the period of 2–4 weeks in 100 % of cases. With the removal of >100 km the diagnosis delay <2 weeks, 2–4 weeks, ≥4–≤8 weeks, >8 weeks was observed in 30, 30, 20 and 20 %, respectively (p=0.78). Conclusion. The distance from the third-level hospital did not affect the period of diagnosis of AL in children, which is achieved by holding daily on-line conferences with country hospitals and out-patient departments followed by the rapid hospitalization of children with suspected oncohematological disorders in the specialized department.
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来源期刊
Siberian journal of oncology
Siberian journal of oncology Medicine-Oncology
CiteScore
0.40
自引率
0.00%
发文量
117
审稿时长
8 weeks
期刊介绍: The main objectives of the journal are: -to promote the establishment of Russia’s leading worldwide positions in the field of experimental and clinical oncology- to create the international discussion platform intended to cover all aspects of basic and clinical cancer research, including carcinogenesis, molecular biology, epidemiology, cancer prevention, diagnosis and multimodality treatment (surgery, chemotherapy, radiation therapy, hormone therapy), anesthetic management, medical and social rehabilitation, palliative care as well as the improvement of life quality of cancer patients- to encourage promising young scientists to be actively involved in cancer research programs- to provide a platform for researches and doctors all over the world to promote, share, and discuss various new issues and developments in cancer related problems. (to create a communication platform for the expansion of cooperation between Russian and foreign professional associations).- to provide the information about the latest worldwide achievements in different fields of oncology The most important tasks of the journal are: -to encourage scientists to publish their research results- to offer a forum for active discussion on topics of major interest - to invite the most prominent Russian and foreign authors to share their latest research findings with cancer research community- to promote the exchange of research information, clinical experience, current trends and the recent developments in the field of oncology as well as to review interesting cases encountered by colleagues all over the world- to expand the editorial board and reviewers with the involvement of well-known Russian and foreign experts- to provide open access to full text articles- to include the journal into the international database- to increase the journal’s impact factor- to promote the journal to the International and Russian markets
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