University of Montreal Hospital Research Centre, Montreal, QC, Canada.
Institut national de santé publique du Québec, Montreal, QC, Canada.
Int J Cancer. 2019 Oct 15;145(8):2061-2069. doi: 10.1002/ijc.32158. Epub 2019 Feb 8.
We sought to determine if neonatal phototherapy is associated with a greater risk of childhood cancer. We conducted a retrospective cohort study of 786,998 infants born in hospitals of Quebec, Canada between 2006 and 2016, with 4,660,868 person-years of follow-up over an 11-year period. The exposures were neonatal phototherapy (32,314 or 4.1% of infants) and untreated jaundice (91,855 or 11.7% of infants). The outcome was hospitalization for solid or hematopoietic childhood tumours between 2 months and 11 years of age. We used Cox proportional hazards regression models to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association of phototherapy with childhood cancer, adjusted for infant characteristics. The incidence of childhood cancer was higher for infants with phototherapy (25.1 per 100,000 person-years) and untreated jaundice (23.0 per 100,000) compared to unexposed infants (21.6 per 100,000). Phototherapy appeared to be associated with late onset solid tumours, including brain/central nervous system cancers. Between age 4 and 11 years, children who received neonatal phototherapy had more than 2 times the risk of any solid tumour compared to unexposed children (HR 2.26, 95% CI 1.34-3.81). Results were similar for phototherapy compared against untreated jaundice. A similar trend was however less apparent for hematopoietic cancer. We conclude that neonatal phototherapy may be associated with a slightly increased risk of solid tumours in childhood, but cannot rule out an effect of bilirubin. Minimizing unnecessary exposure to phototherapy through adherence to recommended thresholds for treatment is encouraged.
我们旨在确定新生儿光疗是否会增加儿童癌症的风险。我们对 2006 年至 2016 年期间在加拿大魁北克省医院出生的 786998 名婴儿进行了回顾性队列研究，在 11 年期间随访了 4660868 人年。暴露因素为新生儿光疗（32314 例或 4.1%的婴儿）和未治疗的黄疸（91855 例或 11.7%的婴儿）。结果是在 2 个月至 11 岁之间因实体或血液系统儿童肿瘤住院。我们使用 Cox 比例风险回归模型计算了光疗与儿童癌症之间的风险比（HR）和 95%置信区间（CI），调整了婴儿特征。与未暴露的婴儿相比，接受光疗的婴儿（25.1/100,000 人年）和未治疗的黄疸（23.0/100,000）的儿童癌症发病率更高（21.6/100,000）。光疗似乎与迟发性实体瘤有关，包括脑/中枢神经系统癌症。在 4 至 11 岁之间，接受新生儿光疗的儿童患任何实体瘤的风险是未暴露儿童的 2 倍以上（HR 2.26，95%CI 1.34-3.81）。与未治疗的黄疸相比，光疗的结果相似。然而，对于血液系统癌症，这种趋势则不太明显。我们的结论是，新生儿光疗可能与儿童实体瘤的风险略有增加有关，但不能排除胆红素的影响。鼓励通过遵守治疗建议的阈值来尽量减少对光疗的不必要暴露。
