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通过回顾性单中心研究探讨共济失调毛细血管扩张症患者的癌症发病情况和类型。

The incidence and type of cancer in patients with ataxia-telangiectasia via a retrospective single-centre study.

机构信息

Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt/Main, Germany.

出版信息

Br J Haematol. 2021 Sep;194(5):879-887. doi: 10.1111/bjh.17736. Epub 2021 Aug 1.

Abstract

Ataxia-telangiectasia (A-T) is a hereditary immune system disorder with neurodegeneration. Its first neurologic symptoms include ataxic gait in early childhood, with slowly progressive cerebellar ataxia, oculomotor apraxia, oculocutaneous telangiectasia, and progressive muscle weakness. Neonatal screening for severe T-cell deficiency was recently found to diagnose A-T patients with a significantly reduced naïve T-cell pool. Our study includes 69 A-T patients between 8 January 2002 and 1 December 2019. Nineteen cases of cancer were diagnosed in 17 patients (25%), with a median overall survival [OS; 95% cumulative indcidence (CI)] of 26·9 years for the entire cohort. The 15-year OS of 82·5% (72-95%) was significantly decreased among A-T patients with malignancies, who had a median OS of 2·11 years, with a two-year-estimated OS of 50·7% (31-82%). Haematological malignancies were the major causes of death within the initial years of life with a 15 times increased risk for death [HR (95% CI): 6·9 (3·1-15.2), P < 0·001] upon malignancy diagnosis. Male patients with A-T are at a higher cancer risk than their female counterparts. This manuscript highlights the need for cancer surveillance and prevention, as well as optimal treatment in this cohort.

摘要

共济失调毛细血管扩张症(A-T)是一种具有神经退行性病变的遗传性免疫系统疾病。其首发的神经系统症状包括儿童早期的共济失调步态,随后进行性小脑共济失调、眼球运动不能、眼皮肤毛细血管扩张和进行性肌肉无力。最近发现,新生儿 T 细胞严重缺乏症的筛查可诊断出 T 细胞池明显减少的 A-T 患者。本研究纳入了 2002 年 1 月 8 日至 2019 年 12 月 1 日期间的 69 例 A-T 患者。17 例患者中诊断出 19 例癌症(25%),全队列的中位总生存期(OS;95%累积发病率(CI))为 26.9 年。有恶性肿瘤的 A-T 患者的 15 年 OS 显著降低(82.5%[72-95%]),中位 OS 为 2.11 年,两年估计 OS 为 50.7%(31-82%)。血液系统恶性肿瘤是导致生命早期死亡的主要原因,其死亡风险增加 15 倍[风险比(HR)(95%CI):6.9(3.1-15.2),P<0.001]。A-T 男性患者的癌症风险高于女性。本研究强调了对该队列进行癌症监测、预防以及优化治疗的必要性。

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