Department of Pediatric Urology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA.
Department of Pediatric Urology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA.
Pediatr Blood Cancer. 2021 Oct;68(10):e29226. doi: 10.1002/pbc.29226. Epub 2021 Jul 10.
Two chemotherapeutic agents used widely in pediatric oncology are vincristine (VCR) and doxorubicin (DOX), which may cause neuropathy and myopathy, respectively. The study hypothesis is that neurotoxic effects of VCR and/or myotoxic effects of DOX affect bladder physiology and manifest clinically as lower urinary tract dysfunction (LUTD).
Based on a priori power analysis, 161 children divided evenly by gender were recruited. Children aged 5-10 years completed the dysfunctional voiding scoring system (DVSS) survey. The study cohort comprised cancer survivors treated with VCR and/or DOX. Healthy controls were recruited from well-child clinic visits. Exclusion criteria included pelvic-based malignancy, pelvic irradiation, pre-existing LUTD, neurologic abnormalities, and treatment with cyclophosphamide/ifosfamide. DVSS scores and presence of LUTD, defined as DVSS scores above gender-specific thresholds (males ≥9, females ≥6), were compared across cohorts.
Median DVSS scores were higher in the study cohort (6 vs. 4, p = .003). Moreover, children in the study cohort were more likely to exceed threshold scores for LUTD (38.8% vs. 21%, p = .014; OR 1.8). Subanalysis by gender revealed female cancer survivors are more likely to report LUTD than controls (57.5% vs. 30%, p = .013, OR 1.9). This did not hold true for males (20% vs. 12.2%, p = .339).
Childhood cancer survivors who received VCR and/or DOX reported higher rates of LUTD than controls. Female cancer survivors appear more likely to suffer from LUTD than males. Further study with a positive control cohort of cancer survivors who received non-VCR, non-DOX chemotherapy is underway to elucidate the contribution of a cancer diagnosis to LUTD.
两种广泛用于儿科肿瘤学的化疗药物分别为长春新碱（VCR）和多柔比星（DOX），它们可能分别导致神经病变和肌病。研究假设是 VCR 的神经毒性作用和/或 DOX 的肌毒性作用会影响膀胱生理功能，并在临床上表现为下尿路功能障碍（LUTD）。
基于先验的功效分析，按性别平均分配，招募了 161 名儿童。年龄在 5-10 岁的儿童完成了排尿功能障碍评分系统（DVSS）调查。研究队列由接受 VCR 和/或 DOX 治疗的癌症幸存者组成。健康对照组从常规儿童就诊中招募。排除标准包括盆腔恶性肿瘤、盆腔放疗、预先存在的 LUTD、神经异常以及环磷酰胺/异环磷酰胺治疗。比较了各队列之间的 DVSS 评分和 LUTD 的存在情况，LUTD 定义为 DVSS 评分高于性别特异性阈值（男性≥9，女性≥6）。
研究队列的中位数 DVSS 评分较高（6 分比 4 分，p=0.003）。此外，研究队列中的儿童更有可能超过 LUTD 的阈值评分（38.8%比 21%，p=0.014；OR 1.8）。按性别进行的亚分析显示，女性癌症幸存者比对照组更有可能报告 LUTD（57.5%比 30%，p=0.013，OR 1.9）。但这在男性中并不成立（20%比 12.2%，p=0.339）。
接受 VCR 和/或 DOX 治疗的儿童癌症幸存者报告的 LUTD 发生率高于对照组。女性癌症幸存者似乎比男性更易患 LUTD。正在对接受非 VCR、非 DOX 化疗的癌症幸存者的阳性对照队列进行进一步研究，以阐明癌症诊断对 LUTD 的贡献。
