Kasteler Rahel, Weiss Annette, Schindler Matthias, Sommer Grit, Latzin Philipp, von der Weid Nicolas X, Ammann Roland A, Kuehni Claudia E
Swiss Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Pediatr Blood Cancer. 2018 Jan;65(1). doi: 10.1002/pbc.26749. Epub 2017 Sep 4.
Pulmonary diseases are potentially severe late complications of childhood cancer treatment that increase mortality risk among survivors. This nationwide study assesses the prevalence and incidence of pulmonary diseases in long-term childhood cancer survivors (CCS) and their siblings, and quantifies treatment-related risks.
As part of the Swiss Childhood Cancer Survivor Study, we studied CCS who were diagnosed between 1976 and 2005 and alive at least 5 years after diagnosis. We compared prevalence of self-reported pulmonary diseases (pneumonia, chest wall abnormalities, lung fibrosis, emphysema) between CCS and their siblings, calculated cumulative incidence of pulmonary diseases using the Kaplan-Meier method, and determined risk factors using multivariable logistic regression.
CCS reported more pneumonias (10% vs. 7%, P = 0.020) and chest wall abnormalities (2% vs. 0.4%, P = 0.003) than siblings. Treatment with busulfan was associated with prevalence of pneumonia (odds ratio [OR] 4.0, 95% confidence interval [CI] 1.1-14.9), and thoracic surgery was associated with chest wall abnormalities and lung fibrosis (OR 4.1, 95% CI 1.6-10.7 and OR 6.3, 95% CI 1.7-26.6). Cumulative incidence of any pulmonary disease after 35 years of follow-up was 21%. For pneumonia, the highest cumulative incidence was seen in CCS treated with both pulmotoxic chemotherapy and radiotherapy to the thorax (23%).
This nationwide study in CCS found an increased risk for pulmonary diseases, especially pneumonia, while still young, which indicates that CCS need long-term pulmonary follow-up.
肺部疾病是儿童癌症治疗潜在的严重晚期并发症，会增加幸存者的死亡风险。这项全国性研究评估了长期儿童癌症幸存者（CCS）及其兄弟姐妹中肺部疾病的患病率和发病率，并对治疗相关风险进行了量化。
作为瑞士儿童癌症幸存者研究的一部分，我们研究了1976年至2005年间确诊且诊断后至少存活5年的CCS。我们比较了CCS与其兄弟姐妹之间自我报告的肺部疾病（肺炎、胸壁异常、肺纤维化、肺气肿）的患病率，使用Kaplan-Meier方法计算肺部疾病的累积发病率，并使用多变量逻辑回归确定风险因素。
与兄弟姐妹相比，CCS报告的肺炎（10%对7%，P = 0.020）和胸壁异常（2%对0.4%，P = 0.003）更多。白消安治疗与肺炎患病率相关（比值比[OR] 4.0，95%置信区间[CI] 1.1 - 14.9），胸外科手术与胸壁异常和肺纤维化相关（OR 4.1，95% CI 1.6 - 10.7和OR 6.3，95% CI 1.7 - 26.6）。随访35年后任何肺部疾病的累积发病率为21%。对于肺炎，在接受肺毒性化疗和胸部放疗的CCS中累积发病率最高（23%）。
这项针对CCS的全国性研究发现，CCS在年轻时患肺部疾病尤其是肺炎的风险增加，这表明CCS需要长期的肺部随访。
