Department of Sports and Health Sciences, College of Life and Environmental Sciences, St Luke's Campus, University of Exeter, Exeter, EX1 2LU, UK; Child Life and Health, University of Edinburgh, Edinburgh, EH9 1UW, UK.
School of Medicine, College of MVLS, University of Glasgow, New Lister Building/Glasgow Royal Infirmary, G31 2ER, UK.
Clin Nutr. 2021 May;40(5):2923-2935. doi: 10.1016/j.clnu.2021.03.020. Epub 2021 Mar 20.
Research reporting plasma micronutrient status and its impact on clinical outcomes in paediatric cancer is scarce. Therefore, we investigated the prevalence of plasma micronutrient abnormalities and their impact on clinical outcomes and treatment complications.
A multicentre prospective-cohort study of children aged <18 years diagnosed with cancer was performed between Aug 2010-Jan 2014. Clinical and nutritional data were collected at diagnosis, 3, 6, 9, 12 and 18 months. Micronutrient status was established using in-house laboratory references (vitamin B12, vitamin A and Vitamin E/Ch) and aged adjusted Z-scores (Mg, Se, Zn and Cu) generated from a cohort of healthy Scottish children. Clinical outcomes were classified as "event free survival (EFS)" or "event" (relapse, death, new metastasis or becoming palliative) and treatment complications. Descriptive statistics, logistic regression and multilevel analysis were performed.
Eighty-two patients [median (IQR) 3.9 (1.9-8.8) years, 56% males] were recruited. Of these, 72 (88%) samples were available, 74% (53/72) patients had micronutrient abnormalities at baseline; deficiencies (25%, 18/72), excesses (19%, 14/72) and a combination of both (29%, 21/72), which continued for 18 months. Vitamin A deficiency (15%, 3/20) and excess (50%, 10/20) were most prevalent at 18 months, whilst vitamin E/Cholesterol and vitamin B12 were mostly within the normal range. Prevalence of Zn deficiency at diagnosis was 36% (16/44 adjusted for CRP), which remained at these levels throughout the study. Reduction in each selenium concentration unit increased the odds of an event by 2% (OR 0.02) and lower Se predicted higher complications at diagnosis [β (-1.2); t (-2.1); 95% CI (-2.9 - (-0.04)); p = 0.04], 3 months [β (-3.9); t (-4.2); 95% CI (-5.57 - (-2.02)); p < 0.001] and 12 months [β (-2.3); t (-2.4); 95% CI (-4.10 - (-0.34)); p = 0.02].
Given the prevalence of micronutrient abnormalities and the negative impact of low selenium on clinical outcome, micronutrient status should be assessed and monitored in paediatric cancer patients. Larger multicentre population based studies and clinical trials are now warranted.
儿科癌症患者的血浆微量营养素状况及其对临床结果的影响的研究报告很少。因此，我们调查了血浆微量营养素异常的发生率及其对临床结果和治疗并发症的影响。
对 2010 年 8 月至 2014 年 1 月期间诊断为癌症的<18 岁儿童进行了一项多中心前瞻性队列研究。在诊断时、3、6、9、12 和 18 个月时收集临床和营养数据。使用内部实验室参考值（维生素 B12、维生素 A 和维生素 E/Ch）和从苏格兰健康儿童队列中生成的年龄调整 Z 分数（Mg、Se、Zn 和 Cu）确定微量营养素状态。临床结果分为“无事件生存（EFS）”或“事件”（复发、死亡、新转移或成为姑息治疗）和治疗并发症。进行描述性统计、逻辑回归和多级分析。
共招募了 82 名患者[中位数（IQR）3.9（1.9-8.8）岁，56%为男性]。其中，72 名（88%）患者有 74%（53/72）的样本在基线时存在微量营养素异常；缺乏（25%，18/72）、过量（19%，14/72）和两者兼而有之（29%，21/72），并持续了 18 个月。维生素 A 缺乏（15%，3/20）和过量（50%，10/20）在 18 个月时最为常见，而维生素 E/Cholesterol 和维生素 B12 则大多在正常范围内。诊断时锌缺乏的患病率为 36%（44 名患者中有 16 名调整 CRP），整个研究期间均保持在这一水平。硒浓度单位每降低一个单位，事件的几率就会增加 2%（OR 0.02），而较低的硒预示着诊断时并发症更高[β（-1.2）；t（-2.1）；95%CI（-2.9-（-0.04））；p=0.04]、3 个月时[β（-3.9）；t（-4.2）；95%CI（-5.57-（-2.02））；p<0.001]和 12 个月时[β（-2.3）；t（-2.4）；95%CI（-4.10-（-0.34））；p=0.02]。
鉴于微量营养素异常的普遍性和低硒对临床结果的负面影响，应评估和监测儿科癌症患者的微量营养素状况。现在需要进行更大规模的多中心人群研究和临床试验。
