Chiou Wen-Yen, Hung Shih-Kai, Lai Chun-Liang, Lin Hon-Yi, Su Yu-Chieh, Chen Yi-Chun, Shen Bing-Jie, Chen Liang-Cheng, Tsai Shiang-Jiun, Lee Moon-Sing, Li Chung-Yi
From the Department of Radiation Oncology, Buddhist Dalin Tzu Chi Hospital, Chiayi (W-YC, S-KH, H-YL, B-JS, L-CC, S-JT, M-SL); School of Medicine, Tzu Chi University, Hualien (W-YC, S-KH, C-LL, H-YL, Y-CS, Y-CC, M-SL); Department of Public Health, College of Medicine, National Cheng Kung University, Tainan (W-YC, C-YL); Department of Internal Medicine, Division of Chest Medicine (C-LL); Department of Internal Medicine, Division of Hematology Oncology (Y-CS); and Department of Internal Medicine, Division of Nephrology, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan. (Y-CC).
Medicine (Baltimore). 2015 Jul;94(26):e1022. doi: 10.1097/MD.0000000000001022.
To evaluate effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPSV23) inoculated during defined "vaccination period," first 6 months post cancer diagnosis (ie, an anti-cancer treatment period), in elderly lung cancer patients on community-acquired pneumonia (CAP) hospitalization incidence.This was a nationwide population-based cohort study of 157 newly diagnosed elderly lung cancer patients receiving PPSV23 during "vaccination period", and 628 age and sex one-to-one matched controls enrolled in the National Health Insurance Research Database (NHIRD) of Taiwan between 2007 and 2010. All patients were ≥75 years old and still survival post "vaccination period." Incidence density (ID) of all-cause inpatient CAP and cumulative survival risk were analyzed by multivariate Poisson regression and Kaplan-Meier method, respectively.After a 4-year follow-up, IDs of all-cause inpatient CAP for vaccination and control cohorts were 297 and 444 per 1000 PYs, respectively. Less vaccinated patients had CAP incidence density >1 time per PY (12.7% vs 21.2%) than non-vaccinated patients. After adjusting for potential confounding variables, like influenza vaccination, comorbidities, cancer treatment modalities, and socioeconomic status, adjusted inpatient CAP incidence rate in PPSV23 vaccination cohort was 0.74 times lower than control cohort (incidence rate ratio [IRR] = 0.740, P = 0.0339). Two-year cumulative CAP hospitalization rates and overall survival rates were 37.1% vs. 55.4%, and 46.6% vs. 26.2%, respectively, for lung cancer patients with and without PPSV23 (both P < 0.001). Subgroup analysis showed that for elderly lung cancer patients not ever receiving influenza vaccine, PPSV23 still had trend to reduce all-cause inpatient CAP.For elderly lung cancer patients aged ≥75 years, PPSV23 inoculated during anti-cancer treatment period could reduce CAP hospitalizations and improve survival.
为评估23价肺炎球菌多糖疫苗（PPSV23）在特定“疫苗接种期”（即癌症诊断后的前6个月，也就是抗癌治疗期）接种对老年肺癌患者社区获得性肺炎（CAP）住院发生率的有效性。这是一项基于全国人口的队列研究，研究对象为2007年至2010年期间在台湾国民健康保险研究数据库（NHIRD）中登记的157例在“疫苗接种期”接受PPSV23的新诊断老年肺癌患者，以及628例年龄和性别一对一匹配的对照。所有患者年龄均≥75岁，且在“疫苗接种期”后仍存活。分别采用多变量泊松回归和Kaplan-Meier方法分析全因住院CAP的发病率密度（ID）和累积生存风险。经过4年随访，疫苗接种组和对照组全因住院CAP的ID分别为每1000人年297例和444例。接种疫苗的患者中CAP发病率密度>每年1次的比例（12.7%对21.2%）低于未接种疫苗的患者。在调整了潜在混杂变量（如流感疫苗接种、合并症、癌症治疗方式和社会经济状况）后，PPSV23疫苗接种组的调整后住院CAP发病率比对照组低0.74倍（发病率比[IRR]=0.740，P=0.0339）。接种和未接种PPSV23疫苗的肺癌患者的两年累积CAP住院率和总生存率分别为37.1%对55.4%和46.6%对26.2%（均P<0.001）。亚组分析表明，对于从未接种过流感疫苗的老年肺癌患者，PPSV23仍有降低全因住院CAP的趋势。对于年龄≥75岁的老年肺癌患者，在抗癌治疗期接种PPSV23可减少CAP住院并提高生存率。
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