Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark.
JNCI Cancer Spectr. 2022 Mar 2;6(2). doi: 10.1093/jncics/pkac029.
Survivors of childhood acute lymphoblastic leukemia (ALL) may be at increased long-term risk of hospitalization for somatic diseases. However, large population-based cohort studies with risk estimates for survivors successfully cured without experiencing a relapse or requiring hematopoietic stem cell transplantation (HSCT) are lacking.
Danish and Swedish patients diagnosed with ALL before age 20 years in 1982-2008 were identified in the national cancer registries. Five-year survivors and matched population comparisons without childhood cancer were followed for hospitalization for 120 somatic disease categories in the national hospital registries from 5 years postdiagnosis until 2017, and disease-specific hospitalization rate ratios (RR) were calculated. The mean cumulative count method was used to estimate the mean number of multiple and recurrent disease-specific hospitalizations per individual.
A total of 2024 5-year survivors and 9797 population comparisons were included. The overall hospitalization rate was more than twice as high compared with comparisons (RR = 2.30, 95% confidence interval [CI] = 2.09 to 2.52). At 30 years postdiagnosis, the mean cumulative hospitalization count was 1.69 (95% CI = 1.47 to 1.90) per survivor and 0.80 (95% CI = 0.73 to 0.86) per comparison. In the subcohort without relapse or HSCT (n = 1709), the RR was 1.41 (95% CI = 1.27 to 1.58).
Survivors of childhood ALL were at increased long-term risk for disease-specific hospitalizations; however, in survivors without relapse or HSCT, the rate was only modestly higher than in population comparisons without a childhood cancer. The absolute mean numbers of multiple and recurrent hospitalizations were generally low.
儿童急性淋巴细胞白血病 (ALL) 的幸存者可能存在长期住院治疗躯体疾病的风险增加。然而，缺乏成功治愈、未复发或无需进行造血干细胞移植 (HSCT) 的幸存者的大型基于人群的队列研究来估计风险。
在丹麦和瑞典，通过国家癌症登记处，确定了 1982-2008 年期间诊断为 ALL 的 20 岁以下的患者。对 5 年无病生存者和无儿童癌症的匹配人群进行了 5 年的随访，随访时间从诊断后 5 年开始，一直持续到 2017 年，通过国家住院登记处记录了 120 种躯体疾病类别的住院情况，并计算了疾病特异性住院率比 (RR)。采用平均累计计数法估计了个体多次和复发性疾病特异性住院的平均次数。
共纳入了 2024 名 5 年无病生存者和 9797 名匹配人群对照。与对照相比，总体住院率高出两倍以上（RR=2.30，95%置信区间 [CI]：2.09 至 2.52）。在诊断后 30 年时，每位幸存者的平均累计住院次数为 1.69（95% CI：1.47 至 1.90），而每位对照的平均累计住院次数为 0.80（95% CI：0.73 至 0.86）。在未复发或未接受 HSCT 的亚组（n=1709）中，RR 为 1.41（95% CI：1.27 至 1.58）。
儿童 ALL 的幸存者长期存在疾病特异性住院治疗的风险增加；然而，在未复发或未接受 HSCT 的幸存者中，这一风险仅略高于无儿童癌症的人群对照。多次和复发性住院的绝对平均次数通常较低。
