Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada.
Thromb Haemost. 2018 Sep;118(9):1646-1655. doi: 10.1055/s-0038-1668543. Epub 2018 Aug 13.
There is conflicting information about the epidemiology of thromboembolism (TE) in paediatric oncology. Objectives were to describe the incidence and risk factors of TE in children with cancer. We included all children with cancer less than 15 years of age diagnosed from 2001 to 2016, treated at one of the 12 Canadian paediatric centres outside of Ontario and entered into the Cancer in Young People-Canada database. Potential risk factors for TE were evaluated using Cox proportional hazards regression stratified by haematological malignancies versus solid tumours. Factors associated with vascular access- and non-vascular access-related TE were compared using chi-square or Fisher's exact tests. Of the 7,471 children included, 283 experienced TE requiring medical intervention; cumulative incidence of TE at 5 years was 3.8 ± 0.2% and 0.36% ± 0.07% for life-threatening or fatal TE. For haematological malignancies, the following factors were associated with TE in multivariable regression: age < 1 year, 5 to 9.99 years and 10 to 14.99 years (relative to age 1-4.99 years), haematopoietic stem cell transplant (hazard ratio [HR] = 1.49, 95% confidence interval [CI], 1.00-2.32), anthracyclines (HR = 2.21, 95% CI, 1.12-4.37) and asparaginase (HR = 1.68, 95% CI, 1.15-2.44). For solid tumours, obesity (HR = 1.92, 95% CI, 1.01-3.68), surgery (HR = 2.70, 95% CI, 1.44-5.08), radiation (HR = 47.51, 95% CI, 24.01-94.01), anthracyclines (HR = 2.74, 95% CI, 1.29-5.82) and platinum agents (HR = 2.26, 95% CI, 1.19-4.28) were associated with TE. Life-threatening and fatal TEs were more common among non-vascular access TEs (14.5% vs. 3.3% = 0.001). In a population-based cohort, 4% of children with cancer developed a clinically significant TE. Accurate risk stratification tools are needed specific to malignancy type.
关于儿科肿瘤学中血栓栓塞症（TE）的流行病学存在相互矛盾的信息。目的是描述癌症儿童中 TE 的发生率和危险因素。我们纳入了所有 2001 年至 2016 年在安大略省以外的 12 家加拿大儿科中心之一诊断为癌症且年龄小于 15 岁的儿童，并将其纳入加拿大青少年癌症数据库。使用 Cox 比例风险回归，按血液恶性肿瘤与实体瘤分层，评估 TE 的潜在危险因素。使用卡方或 Fisher 精确检验比较血管内和非血管内相关 TE 的相关因素。在纳入的 7471 名儿童中，有 283 名发生需要医疗干预的 TE；5 年 TE 的累积发生率为 3.8±0.2%，危及生命或致命性 TE 的发生率为 0.36%±0.07%。对于血液恶性肿瘤，多变量回归分析中与 TE 相关的因素包括：年龄<1 岁、5-9.99 岁和 10-14.99 岁（与 1-4.99 岁相比）、造血干细胞移植（风险比[HR]1.49，95%置信区间[CI]1.00-2.32）、蒽环类药物（HR2.21，95%CI1.12-4.37）和门冬酰胺酶（HR1.68，95%CI1.15-2.44）。对于实体瘤，肥胖（HR1.92，95%CI1.01-3.68）、手术（HR2.70，95%CI1.44-5.08）、放疗（HR47.51，95%CI24.01-94.01）、蒽环类药物（HR2.74，95%CI1.29-5.82）和铂类药物（HR2.26，95%CI1.19-4.28）与 TE 相关。危及生命和致命的 TE 在非血管内 TE 中更为常见（14.5%比 3.3%=0.001）。在基于人群的队列中，4%的癌症儿童发生了有临床意义的 TE。需要针对特定恶性肿瘤类型的准确风险分层工具。
