Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA.
Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
Pediatr Hematol Oncol. 2021 Apr;38(3):239-250. doi: 10.1080/08880018.2020.1842952. Epub 2020 Nov 10.
Malnutrition is associated with treatment-related toxicities (TRT) in adults with solid tumors and in children with leukemia. Few studies have assessed whether malnutrition in pediatric patients treated for solid tumors impacts risk for TRT, relapse, and/or survival. To address this knowledge gap, this retrospective study evaluated the association between body mass index (BMI) at diagnosis, and imputed BMI during therapy, on the prevalence of TRT, specific toxicities, relapse, and survival in pediatric patients with solid tumors treated with cisplatin-containing regimens. Kaplan-Meier curves and regression models evaluated the association between patient-specific characteristics (including BMI) and TRT, relapse, and survival. The cohort included 221 patients, of whom 22% were malnourished at diagnosis (10% were underweight and 12% were obese). Most patients (60%) experienced at least one severe TRT, and 30% developed more than one severe TRT. Most patients with obesity at diagnosis remained obese during therapy (62%). In multivariable analysis, obesity at diagnosis was significantly associated with a more than threefold greater risk for developing severe TRT (p = 0.037), specifically for acute or chronic kidney injury ( = 0.014). Obesity at diagnosis and adolescent and young adult age (≥15 years at diagnosis) were associated with worse event-free survival (hazard ratio [HR] 2.32, p = 0.024 and HR 2.28, p = 0.010, respectively) and overall survival (HR 3.69, = 0.006 and HR 2.6, = 0.012, respectively). Obese and older patients therefore constitute populations at risk for poorer outcomes. Prospective studies are warranted to gain further insight into the mechanism and role of obesity and adolescence in developing TRT and/or treatment failure.
营养不良与成人实体瘤和儿童白血病患者的治疗相关毒性（TRT）有关。很少有研究评估接受实体瘤治疗的儿科患者的营养不良是否会影响 TRT、复发和/或生存的风险。为了解决这一知识空白，这项回顾性研究评估了诊断时的体重指数（BMI）和治疗期间推断的 BMI 与接受含顺铂方案治疗的实体瘤儿科患者 TRT、特定毒性、复发和生存的相关性。Kaplan-Meier 曲线和回归模型评估了患者特定特征（包括 BMI）与 TRT、复发和生存之间的关联。该队列包括 221 名患者，其中 22%在诊断时存在营养不良（10%体重不足，12%肥胖）。大多数患者（60%）至少经历过一次严重的 TRT，30%的患者发展为不止一次严重的 TRT。大多数诊断时肥胖的患者在治疗期间仍保持肥胖（62%）。多变量分析显示，诊断时肥胖与发生严重 TRT 的风险增加三倍以上显著相关（p=0.037），特别是与急性或慢性肾损伤相关（p=0.014）。诊断时肥胖和青少年及年轻成人年龄（诊断时≥15 岁）与无事件生存（风险比[HR]2.32，p=0.024 和 HR 2.28，p=0.010）和总生存（HR 3.69，p=0.006 和 HR 2.6，p=0.012）较差相关。因此，肥胖和老年患者构成了预后较差的人群。需要进行前瞻性研究，以进一步深入了解肥胖和青春期在发生 TRT 和/或治疗失败中的机制和作用。
