{"title":"急性淋巴细胞白血病儿童急腹症的多中心研究：CCCG-ALL-2015","authors":"Wenting Gan, Weina Zhang, Jiaoyang Cai, Xiaofan Zhu, Jie Yu, Peifang Xiao, Ju Gao, Yongjun Fang, Changda Liang, Xue Li, Fen Zhou, Xiaowen Zhai, Xiaoxiao Xu, Xin Tian, Aiguo Liu, Ningling Wang, Jiashi Zhu, Frankie Wai-Tsoi Cheng, Liangchun Yang, Ge Zhang, Shuhong Shen, Hua Jiang, Lingzhen Wang","doi":"10.1002/cam4.71090","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>Acute abdomen presents a significant challenge in the treatment of childhood acute lymphoblastic leukemia (ALL), potentially leading to treatment failure and treatment-related mortality. Results from the multicenter study of CCCG-ALL-2015 showed significant improvements in overall survival (OS) and event-free survival (EFS) for childhood ALL. However, the primary aim of this study was to determine the incidence, risk factors, and clinical impact of acute abdomen in the CCCG-ALL-2015 protocol, with the ultimate goal in the future of establishing evidence-based preventive strategies to reduce its occurrence.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Patients participating in the CCCG-ALL-2015 protocol from January 1, 2015, to December 31, 2019, were included in this analysis. The occurrence of acute abdomen in 7640 patients with ALL was analyzed retrospectively. The data was collected in August 2023 from the Data Center. Acute abdomen analyzed in this study included: acute pancreatitis, acute appendicitis, ileus, enterobrosis, enterorrhagia, peritonitis, enteritis, and others (urinary calculus, anaphylactoid purpura, cholecystitis). The clinical data of patients with acute abdomen were extracted from the database and analyzed.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 7640 patients were recruited in the study, and 512 (6.7%) patients diagnosed with acute abdomen were identified. Of the 512 patients, 50 patients experienced two episodes of acute abdomen, 5 patients had three episodes, and 2 patients had four episodes. Among different types of acute abdomen, the incidence of acute pancreatitis was the highest (4.0%), followed by ileus (1.2%) and acute appendicitis (0.7%). There was no difference in the incidence of acute abdomen between males and females (6.6% vs. 6.9%, <i>p</i> = 0.64). The incidence of acute abdomen was associated with age, and patients older than 10 years had a significantly higher incidence rate than those less than 1 year and 1–10 years old (13.0% vs. 5.7%, <i>p</i> < 0.0001). The incidence rate of enterorrhagia was significantly higher in patients less than 1 year and older than 10 years than that in patients aged 1–10 years old (1.4% vs. 0.4%, <i>p</i> < 0.0001). The incidence of acute abdomen in the intermediate or high-risk (I/HR) group was higher than that in the low-risk (LR) group (9.9% vs. 3.7%, <i>p</i> < 0.001). Acute abdomen mainly occurred in the induction remission phase (57.3%) and the continuation and reinduction phase (39.3%). A total of 16 patients died from acute abdomen, including four patients in the LR group and 12 patients in the I/HR group. Among the different types of acute abdomen, the mortality rate of enterorrhagia was the highest (16.7%), followed by enterobrosis (9.1%).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>This multicenter study investigates the frequency, risk factors, and impact of acute abdomen in the CCCG-ALL-2015 protocol, the largest pediatric ALL study in China. We identified acute abdomen in 6.7% of patients, with the highest incidence during the induction remission phase and in older children and those with intermediate or high-risk ALL. Acute pancreatitis was the most common type, while enterorrhagia had the highest mortality. These findings underscore the need for heightened vigilance and proactive management of acute abdomen to improve outcomes in children with ALL.</p>\n </section>\n \n <section>\n \n <h3> Trial Registration</h3>\n \n <p>Chinese Clinical Trial Registry: ChiCTR-IPR-14005706</p>\n </section>\n </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 16","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.71090","citationCount":"0","resultStr":"{\"title\":\"A Multicenter Study of Acute Abdomen in Children With Acute Lymphoblastic Leukemia: CCCG-ALL-2015\",\"authors\":\"Wenting Gan, Weina Zhang, Jiaoyang Cai, Xiaofan Zhu, Jie Yu, Peifang Xiao, Ju Gao, Yongjun Fang, Changda Liang, Xue Li, Fen Zhou, Xiaowen Zhai, Xiaoxiao Xu, Xin Tian, Aiguo Liu, Ningling Wang, Jiashi Zhu, Frankie Wai-Tsoi Cheng, Liangchun Yang, Ge Zhang, Shuhong Shen, Hua Jiang, Lingzhen Wang\",\"doi\":\"10.1002/cam4.71090\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>Acute abdomen presents a significant challenge in the treatment of childhood acute lymphoblastic leukemia (ALL), potentially leading to treatment failure and treatment-related mortality. Results from the multicenter study of CCCG-ALL-2015 showed significant improvements in overall survival (OS) and event-free survival (EFS) for childhood ALL. However, the primary aim of this study was to determine the incidence, risk factors, and clinical impact of acute abdomen in the CCCG-ALL-2015 protocol, with the ultimate goal in the future of establishing evidence-based preventive strategies to reduce its occurrence.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Patients participating in the CCCG-ALL-2015 protocol from January 1, 2015, to December 31, 2019, were included in this analysis. The occurrence of acute abdomen in 7640 patients with ALL was analyzed retrospectively. The data was collected in August 2023 from the Data Center. Acute abdomen analyzed in this study included: acute pancreatitis, acute appendicitis, ileus, enterobrosis, enterorrhagia, peritonitis, enteritis, and others (urinary calculus, anaphylactoid purpura, cholecystitis). The clinical data of patients with acute abdomen were extracted from the database and analyzed.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>A total of 7640 patients were recruited in the study, and 512 (6.7%) patients diagnosed with acute abdomen were identified. Of the 512 patients, 50 patients experienced two episodes of acute abdomen, 5 patients had three episodes, and 2 patients had four episodes. Among different types of acute abdomen, the incidence of acute pancreatitis was the highest (4.0%), followed by ileus (1.2%) and acute appendicitis (0.7%). There was no difference in the incidence of acute abdomen between males and females (6.6% vs. 6.9%, <i>p</i> = 0.64). The incidence of acute abdomen was associated with age, and patients older than 10 years had a significantly higher incidence rate than those less than 1 year and 1–10 years old (13.0% vs. 5.7%, <i>p</i> < 0.0001). The incidence rate of enterorrhagia was significantly higher in patients less than 1 year and older than 10 years than that in patients aged 1–10 years old (1.4% vs. 0.4%, <i>p</i> < 0.0001). The incidence of acute abdomen in the intermediate or high-risk (I/HR) group was higher than that in the low-risk (LR) group (9.9% vs. 3.7%, <i>p</i> < 0.001). Acute abdomen mainly occurred in the induction remission phase (57.3%) and the continuation and reinduction phase (39.3%). A total of 16 patients died from acute abdomen, including four patients in the LR group and 12 patients in the I/HR group. Among the different types of acute abdomen, the mortality rate of enterorrhagia was the highest (16.7%), followed by enterobrosis (9.1%).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>This multicenter study investigates the frequency, risk factors, and impact of acute abdomen in the CCCG-ALL-2015 protocol, the largest pediatric ALL study in China. 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引用次数: 0
摘要
急腹症是儿童急性淋巴细胞白血病（ALL）治疗中的一个重大挑战，可能导致治疗失败和治疗相关死亡率。CCCG-ALL-2015的多中心研究结果显示，儿童ALL的总生存期（OS）和无事件生存期（EFS）显著改善。然而，本研究的主要目的是确定CCCG-ALL-2015方案中急腹症的发生率、危险因素和临床影响，最终目标是在未来建立以证据为基础的预防策略以减少急腹症的发生。方法将2015年1月1日至2019年12月31日参加CCCG-ALL-2015方案的患者纳入分析。回顾性分析7640例ALL患者急腹症的发生情况。数据是在2023年8月从数据中心收集的。本研究分析的急腹包括：急性胰腺炎、急性阑尾炎、肠梗阻、肠黑、肠出血、腹膜炎、肠炎等（尿路结石、过敏性紫癜、胆囊炎）。从数据库中提取急腹症患者的临床资料进行分析。结果共纳入7640例患者，其中512例（6.7%）诊断为急腹症。512例患者中，50例出现2次急腹症，5例出现3次急腹症，2例出现4次急腹症。不同急腹症类型中，急性胰腺炎的发病率最高（4.0%），其次是肠梗阻（1.2%）和急性阑尾炎（0.7%）。男性和女性的急腹症发生率无差异（6.6%比6.9%,p = 0.64）。急腹症的发病率与年龄相关，10岁以上患者的发病率明显高于1岁以下和1 - 10岁患者（13.0% vs. 5.7%, p < 0.0001）。1岁以下和10岁以上患者肠出血发生率明显高于1 - 10岁患者（1.4% vs. 0.4%, p < 0.0001）。中高危（I/HR）组急腹症发生率高于低危（LR）组（9.9% vs. 3.7%, p < 0.001）。急腹症主要发生在诱导缓解期（57.3%）和持续再诱导期（39.3%）。共有16例患者死于急腹症，其中LR组4例，I/HR组12例。不同急腹症类型中，肠出血死亡率最高（16.7%），其次是肠坏死（9.1%）。本多中心研究调查了CCCG-ALL-2015方案中急腹症的发生频率、危险因素和影响，CCCG-ALL-2015是中国最大的儿科ALL研究。我们在6.7%的患者中发现了急腹症，在诱导缓解期、大龄儿童和中度或高风险ALL患者中发病率最高。急性胰腺炎是最常见的类型，而肠出血的死亡率最高。这些发现强调了提高警惕和积极管理急腹症的必要性，以改善ALL患儿的预后。中国临床试验注册中心：ChiCTR-IPR-14005706
A Multicenter Study of Acute Abdomen in Children With Acute Lymphoblastic Leukemia: CCCG-ALL-2015
Objective
Acute abdomen presents a significant challenge in the treatment of childhood acute lymphoblastic leukemia (ALL), potentially leading to treatment failure and treatment-related mortality. Results from the multicenter study of CCCG-ALL-2015 showed significant improvements in overall survival (OS) and event-free survival (EFS) for childhood ALL. However, the primary aim of this study was to determine the incidence, risk factors, and clinical impact of acute abdomen in the CCCG-ALL-2015 protocol, with the ultimate goal in the future of establishing evidence-based preventive strategies to reduce its occurrence.
Methods
Patients participating in the CCCG-ALL-2015 protocol from January 1, 2015, to December 31, 2019, were included in this analysis. The occurrence of acute abdomen in 7640 patients with ALL was analyzed retrospectively. The data was collected in August 2023 from the Data Center. Acute abdomen analyzed in this study included: acute pancreatitis, acute appendicitis, ileus, enterobrosis, enterorrhagia, peritonitis, enteritis, and others (urinary calculus, anaphylactoid purpura, cholecystitis). The clinical data of patients with acute abdomen were extracted from the database and analyzed.
Results
A total of 7640 patients were recruited in the study, and 512 (6.7%) patients diagnosed with acute abdomen were identified. Of the 512 patients, 50 patients experienced two episodes of acute abdomen, 5 patients had three episodes, and 2 patients had four episodes. Among different types of acute abdomen, the incidence of acute pancreatitis was the highest (4.0%), followed by ileus (1.2%) and acute appendicitis (0.7%). There was no difference in the incidence of acute abdomen between males and females (6.6% vs. 6.9%, p = 0.64). The incidence of acute abdomen was associated with age, and patients older than 10 years had a significantly higher incidence rate than those less than 1 year and 1–10 years old (13.0% vs. 5.7%, p < 0.0001). The incidence rate of enterorrhagia was significantly higher in patients less than 1 year and older than 10 years than that in patients aged 1–10 years old (1.4% vs. 0.4%, p < 0.0001). The incidence of acute abdomen in the intermediate or high-risk (I/HR) group was higher than that in the low-risk (LR) group (9.9% vs. 3.7%, p < 0.001). Acute abdomen mainly occurred in the induction remission phase (57.3%) and the continuation and reinduction phase (39.3%). A total of 16 patients died from acute abdomen, including four patients in the LR group and 12 patients in the I/HR group. Among the different types of acute abdomen, the mortality rate of enterorrhagia was the highest (16.7%), followed by enterobrosis (9.1%).
Conclusion
This multicenter study investigates the frequency, risk factors, and impact of acute abdomen in the CCCG-ALL-2015 protocol, the largest pediatric ALL study in China. We identified acute abdomen in 6.7% of patients, with the highest incidence during the induction remission phase and in older children and those with intermediate or high-risk ALL. Acute pancreatitis was the most common type, while enterorrhagia had the highest mortality. These findings underscore the need for heightened vigilance and proactive management of acute abdomen to improve outcomes in children with ALL.
Trial Registration
Chinese Clinical Trial Registry: ChiCTR-IPR-14005706
期刊介绍：
Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas:
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Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.
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