{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:31:23Z","timestamp":1788449483867,"version":"build-2803163510"},"reference-count":47,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82270147"],"award-info":[{"award-number":["82270147"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Extramedullary disease (EMD) occurs in 1%\u201330% of acute myeloid leukemia (AML) patients and has been associated with adverse outcomes. However, the magnitude of its prognostic impact varies considerably across studies, possibly due to inconsistent terminology and diagnostic approaches. The definition of EMD in AML varies, typically employing three descriptors: EMD (comprehensive), extramedullary infiltration (EMI), and myeloid sarcoma\/granulocytic sarcoma (MS\/GS). This first comprehensive meta\u2010analysis precisely quantifies EMD's prognostic impact, revealing a significant effect on overall survival (OS) (HR\u2009=\u20091.49, 95% CI, 1.34\u20131.67, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and event\u2010free survival (EFS) (HR\u2009=\u20091.38, 95% CI, 1.03\u20131.84, <jats:italic>p<\/jats:italic>\u2009=\u2009.030). Importantly, our subgroup analyses demonstrate that prognostic impact varies significantly by EMD classification. The HR for EMI was 1.88 (95% CI, 1.52\u20132.31, <jats:italic>p<\/jats:italic>\u2009=\u2009.000); for EMD, it was 1.41 (95% CI, 1.20\u20131.66, <jats:italic>p<\/jats:italic>\u2009=\u2009.000); and for MS\/GS, it stood at 1.18 (95% CI, 0.92\u20131.52, <jats:italic>p<\/jats:italic>\u2009=\u2009.188). Additionally, we analyzed the influence of EMD on the OS of AML patients undergoing allogeneic hematopoietic stem cell transplantation (allo\u2010HSCT) and found that allo\u2010HSCT may mitigate EMD's negative prognostic impact (HR\u2009=\u20091.19, 95% CI, 0.97\u20131.46, <jats:italic>p<\/jats:italic>\u2009=\u2009.092; Heterogeneity: <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.0%, <jats:italic>p<\/jats:italic>\u2009=\u2009.860), confirming and quantifying this therapeutic benefit through meta\u2010analysis for the first time. These findings highlight the need for standardized EMD definitions and suggest differential therapeutic approaches based on EMD subtype.<\/jats:p>","DOI":"10.1002\/ijc.70024","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T08:55:13Z","timestamp":1750841713000},"page":"2334-2342","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Prognostic impact of extramedullary disease in acute myeloid leukemia: A meta\u2010analysis"],"prefix":"10.1002","volume":"157","author":[{"given":"Yufan","family":"Lin","sequence":"first","affiliation":[{"name":"Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy Zhejiang University  Zhejiang Hangzhou People's Republic of China"},{"name":"Department of Hematology The First Affiliated Hospital, Zhejiang University School of Medicine  Zhejiang Hangzhou People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Liu","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy Zhejiang University  Zhejiang Hangzhou People's Republic of China"},{"name":"Department of Hematology Harbin Medical University Cancer Hospital  Harbin Heilongjiang People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiqi","family":"Zhuang","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy Zhejiang University  Zhejiang Hangzhou People's Republic of China"},{"name":"Department of Hematology The First Affiliated Hospital, Zhejiang University School of Medicine  Zhejiang Hangzhou People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoren","family":"Deng","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy Zhejiang University  Zhejiang Hangzhou People's Republic of China"},{"name":"Department of Hematology The First Affiliated Hospital, Zhejiang University School of Medicine  Zhejiang Hangzhou People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Liu","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy Zhejiang University  Zhejiang Hangzhou People's Republic of China"},{"name":"Department of Hematology Harbin Medical University Cancer Hospital  Harbin Heilongjiang People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy Zhejiang University  Zhejiang Hangzhou People's Republic of China"},{"name":"Department of Hematology The First Affiliated Hospital, Zhejiang University School of Medicine  Zhejiang Hangzhou People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyan","family":"Tong","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy Zhejiang University  Zhejiang Hangzhou People's Republic of China"},{"name":"Department of Hematology The First Affiliated Hospital, Zhejiang University School of Medicine  Zhejiang Hangzhou People's Republic of China"},{"name":"Zhejiang Provincial Clinical Research Center for Hematological Disorders  Zhejiang Hangzhou People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aichun","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Hematology Harbin Medical University Cancer Hospital  Harbin Heilongjiang People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2999-3689","authenticated-orcid":false,"given":"Jie","family":"Sun","sequence":"additional","affiliation":[{"name":"Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy Zhejiang University  Zhejiang Hangzhou People's Republic of China"},{"name":"Department of Hematology The First Affiliated Hospital, Zhejiang University School of Medicine  Zhejiang Hangzhou People's Republic of China"},{"name":"Zhejiang Provincial Clinical Research Center for Hematological Disorders  Zhejiang Hangzhou People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31041-9"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2023.2185091"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2020.100773"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1995.13.7.1800"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2004.01.006"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/bcj.2017.79"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2014.963080"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hon.994"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.17742"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.12909"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-03-643544"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13045-022-01267-7"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.67.5892"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2017.11.011"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.4084\/MJHID.2021.030"},{"key":"e_1_2_13_17_1","unstructured":"Umin.Phase II study of allogeneic hematopoietic cell transplantation for children with acute myeloid leukemia in first and second complete remission using fludarabine cytarabine melphalan and low\u2010dose total body irradiation as a conditioning regimen (AML\u2010SCT15)."},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-8-16"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2014.11.683"},{"issue":"4","key":"e_1_2_13_20_1","first-page":"980","article-title":"Clinical features and prognosis of t(8;21) AML patients in China: a multicenter retrospective study","volume":"25","author":"Gong D","year":"2017","journal-title":"Zhongguo Shi Yan Xue Ye Xue Za Zhi"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2016.09.001"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2019.0052"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.23691"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1349-7006.2012.02324.x"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2012.156"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/16078454.2022.2056982"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2015.82"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V116.21.2165.2165"},{"key":"e_1_2_13_29_1","first-page":"S105","article-title":"Inferior survival in patients with refractory acute myeloid leukaemia and extramedullary disease or high leukaemia burden after sequential treatment with chemotherapy and reduced\u2010intensity conditioning for allogeneic stem cell transplantation","volume":"41","author":"Harsdorf SSC","year":"2008","journal-title":"Bone Marrow Transplant"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11912-020-00919-6"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2017.02.027"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1177\/20406207221115005"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-023-05288-1"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijnm.IJNM_10_17"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972-3919.198485"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24287"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15184555"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V90.4.1643"},{"key":"e_1_2_13_39_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2022017046"},{"key":"e_1_2_13_40_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1993.11.4.690"},{"key":"e_1_2_13_41_1","doi-asserted-by":"publisher","DOI":"10.4061\/2011\/523168"},{"key":"e_1_2_13_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2010.01.009"},{"key":"e_1_2_13_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2016.04.001"},{"key":"e_1_2_13_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2021.01.004"},{"key":"e_1_2_13_45_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2023.0025"},{"key":"e_1_2_13_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-020-04313-x"},{"key":"e_1_2_13_47_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2015.81"},{"key":"e_1_2_13_48_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"}],"container-title":["International Journal of Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijc.70024","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T15:46:21Z","timestamp":1759592781000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ijc.70024"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,25]]},"references-count":47,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/ijc.70024"],"URL":"https:\/\/doi.org\/10.1002\/ijc.70024","archive":["Portico"],"relation":{},"ISSN":["0020-7136","1097-0215"],"issn-type":[{"value":"0020-7136","type":"print"},{"value":"1097-0215","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,25]]},"assertion":[{"value":"2025-03-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}