Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Higashi-Sapporo 6-6, Shiroishi-ku, Sapporo, Hokkaido, 003-0006, Japan.
Support Care Cancer. 2021 Oct;29(10):5847-5852. doi: 10.1007/s00520-021-06143-7. Epub 2021 Mar 22.
The impact of paranasal sinusitis on the clinical outcome of patients with cancer remains unknown. The aim of this study was to determine whether paranasal sinusitis at the initiation of chemotherapy (SAI) affects the development of infectious complications in children and adolescents with cancer.
A retrospective cohort analysis of patients aged 0-20 years with cancer who received chemotherapy was performed. SAI was defined as the presence of a fluid level or mucosal swelling or total opacity on sinus computed tomography examination before the initiation of chemotherapy. The primary outcome measures were the incidence of bacteremia, septic shock, and invasive fungal disease (IFD, including proven, probable, and possible cases).
SAI was observed in 57 (44%) of 130 enrolled patients. There were no significant differences in age, sex, and disease distribution between the patients with SAI (SAI group) and those without (non-SAI group). There was no significant difference in the 1-year cumulative incidence of bacteremia or septic shock after treatment initiation between the two groups (bacteremia, SAI group 33% vs. non-SAI group 35%, P = 0.53; septic shock, SAI group 4% vs. non-SAI group 4%, P = 0.87). The 1-year cumulative incidence of IFD was higher in the SAI group than in the non-SAI group (22% vs. 6%, P = 0.012). Cumulative incidence analysis after inverse probability of treatment weighting adjustment showed that the SAI group was more likely to develop IFD (HR: 3.5, 95% CI: 1.1-11.2, P = 0.033).
Our findings suggest that patients with SAI may be at higher risk for IFD during chemotherapy.
副鼻窦炎对癌症患者临床结局的影响尚不清楚。本研究旨在确定化疗起始时是否存在副鼻窦炎（SAI）是否会影响儿童和青少年癌症患者感染并发症的发展。
对接受化疗的 0-20 岁癌症患者进行回顾性队列分析。SAI 定义为在化疗开始前鼻窦计算机断层扫描检查存在液平、黏膜肿胀或完全不透明。主要观察指标为菌血症、感染性休克和侵袭性真菌病（IFD，包括确诊、可能和疑似病例）的发生率。
在纳入的 130 例患者中，57 例（44%）存在 SAI。SAI 组和非 SAI 组患者在年龄、性别和疾病分布方面无显著差异。两组患者治疗开始后 1 年内菌血症或感染性休克的 1 年累积发生率无显著差异（菌血症，SAI 组 33% vs. 非 SAI 组 35%，P=0.53；感染性休克，SAI 组 4% vs. 非 SAI 组 4%，P=0.87）。SAI 组 IFD 的 1 年累积发生率高于非 SAI 组（22% vs. 6%，P=0.012）。经过治疗倾向评分逆概率加权调整后的累积发病率分析显示，SAI 组更易发生 IFD（HR：3.5，95%CI：1.1-11.2，P=0.033）。
我们的研究结果表明，SAI 患者在化疗期间可能更易发生 IFD。
