Document Type : Original Article


1 Patient Safety Research Center, Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran

2 Department of Pediatric Hematology, Motahari Hospital, Urmia University of Medical Sciences, Urmia, Iran

3 Department of Pediatrics, Urmia University of Medical Sciences, Urmia, Iran

4 Department of Biostatistics, Hamadan University of Medical Sciences, Hamadan, Iran

5 Solid Tumor Research Center, Urmia University of Medical Sciences, Urmia, Iran

6 Urmia University of Medical Sciences, Urmia, Iran


Background: Acute lymphoblastic leukemia (ALL) accounts for 25% of cancers among children less than 15 years of age. This study aimed to evaluate and determine the prognostic factors affecting the survival of leukemia patients using cumulative incidence function.
Method: This was a retrospective study done on 176 children under 15 who had ALL between 2011 and 2019. Overall survival, event-free survival, disease-free survival (DFS), and non-relapse mortality served as the study's endpoints. Using the Fine-Gray model, the Kaplan-Meier, single-variable, and multivariable analyses were conducted. Schwenfeld weighted residuals were used to test the proportional hazard hypothesis. SAS was used to conduct the analysis.
Results: The hazard ratio (HR) of DFS for effective variables was calculated (girls compared to boys: 0.37 [95% confidence interval (CI): 0.15-0.91], positive testis test: 10.34 [95% CI: 4.44-24.05], children with central nervous system involvement: 2.95 [95% CI: 1.36-6.40], testicular swelling in children: 11.54 [95% CI: 4.21-31.59], children with hepatosplenomegaly larger than 2 cm: 0.30 [95% CI: 0.10-0.88], high risk of disease compared to low risk: 4.76 [95% CI: 1.12-20.22], children with complete remission in 28th day compared with no complete remission: 0.10 [95% CI: 0.04- 0.25]. Only hemoglobin was substantially linked with DFS in the multivariate DFS HR. Children who got radiation had a 77% reduced risk of non-recurrence death than those who did not (HR: 0.23, 95% CI: 0.08-0.60).
Conclusion: Being a girl, having family history, and not having radiotherapy were the main factors to develop death before the first recurrence in children.


How to cite this article:

Khalkhali HR, Noroozi M, Bahadori R, Omidi T, Ghazizadeh F, Hejazi S, et al. Evaluation and diagnosis of prognostic factors affecting the survival of leukemia patients using cumulative incidence function. Middle East J Cancer. 2023;14(1):92-101. doi: 10.30476/ mejc.2022. 89478.1528.

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