Kobe Minimally invasive Cancer Center, Kobe, Japan.
Kobe University Graduate School of Medicine, Kobe, Japan.
Cancer Med. 2021 Nov;10(21):7525-7533. doi: 10.1002/cam4.4269. Epub 2021 Sep 13.
Although rare, cytomegalovirus (CMV) reactivation can be lethal in patients with cancer. However, the criteria for the prevention of cytomegalovirus reactivation during cancer treatment are unclear. This study aimed to identify factors associated with CMV reactivation in patients with esophageal cancer who were receiving chemoradiotherapy.
This retrospective study included esophageal cancer patients receiving definitive or palliative chemoradiotherapy during April 2013-March 2020. Patients with fever during chemoradiotherapy underwent a systemic work-up to detect the primary focus of infection, and CMV antigenemia was assessed in cases of unidentifiable infection.
Among 132 patients (80.3% male, median age 69 years [range, 39-86 years]), 124 received 5-fluorouracil plus cisplatin and 8 received oxaliplatin-5-fluorouracil-levofolinate chemotherapy. Overall, 19 patients had CMV reactivation, 37 had other infections, and 76 had no identified infection (groups 1, 2, and 3, respectively). Median minimum lymphocyte counts were 81.0/µl (interquartile range: 52.0-144.0/µl), 120.0/µl (81.0-162.5/µl), and 185.5/µl (120.5-328.0/µl) in groups 1, 2, and 3, respectively, with counts being significantly lower in groups 1 and 2 than in group 3 (p < 0.001). In multiple logistic regression analysis, the minimum lymphocyte count was associated with CMV reactivation (odds ratio 0.983, 95% confidence interval: 0.973-0.994, p = 0.002).
CMV reactivation is not rare in patients with esophageal cancer who were receiving chemoradiotherapy and is associated with the minimum lymphocyte counts. CMV reactivation should be considered during differential diagnosis for patients with a severe decline in lymphocyte counts when receiving chemoradiotherapy.
巨细胞病毒（CMV）再激活虽然罕见，但在癌症患者中可能致命。然而，癌症治疗期间预防 CMV 再激活的标准尚不明确。本研究旨在确定接受放化疗的食管癌患者发生 CMV 再激活的相关因素。
这是一项回顾性研究，纳入了 2013 年 4 月至 2020 年 3 月期间接受根治性或姑息性放化疗的食管癌患者。放化疗期间发热的患者接受系统检查以确定感染的原发灶，并在无法确定感染源时评估 CMV 抗原血症。
132 例患者（80.3%为男性，中位年龄 69 岁[范围 39-86 岁]）中，124 例接受了氟尿嘧啶联合顺铂化疗，8 例接受了奥沙利铂-氟尿嘧啶-左亚叶酸化疗。总体而言，19 例患者发生 CMV 再激活，37 例患者发生其他感染，76 例患者无明确感染（分别为组 1、组 2 和组 3）。组 1、组 2 和组 3 的最小淋巴细胞计数中位数分别为 81.0/µl（四分位距：52.0-144.0/µl）、120.0/µl（81.0-162.5/µl）和 185.5/µl（120.5-328.0/µl），组 1 和组 2 的计数明显低于组 3（p<0.001）。多因素逻辑回归分析显示，最小淋巴细胞计数与 CMV 再激活相关（比值比 0.983，95%置信区间：0.973-0.994，p=0.002）。
接受放化疗的食管癌患者中 CMV 再激活并不罕见，与最小淋巴细胞计数相关。当接受放化疗的患者淋巴细胞计数严重下降时，应考虑 CMV 再激活的可能性，并进行鉴别诊断。
