Terrones-Campos Cynthia, Ledergerber Bruno, Specht Lena, Vogelius Ivan Richter, Helleberg Marie, Lundgren Jens
Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Adv Radiat Oncol. 2022 Mar 21;7(6):100950. doi: 10.1016/j.adro.2022.100950. eCollection 2022 Nov-Dec.
The incidence, etiology, and association of infections with radiation therapy (RT)-induced lymphopenia in patients with solid tumors is not well elucidated.
We identified possible, probable, and definite infections caused by bacteria, fungi, and viruses, combining data on medication, microbiology, and diagnoses. Definite infections had either a diagnosis or a positive microbiological isolation. We analyzed the incidence and adjusted incidence-rate ratio of infections in the year after the start of RT among patients who received RT plus chemotherapy and RT monotherapy, by type of infection and according to the degree of RT-induced lymphopenia.
A total of 4450 of 6334 (70.3%) patients experienced 11264 infections overall; 1424 (22.5%) patients developed 2104 definite infections in the first year after RT. Infections were more frequent among patients who received RT plus chemotherapy (2590 of 3469; incidence: 16.5 [95% confidence interval {CI}, 16.1-17.0], per 100 patient-years) compared with patients who received RT monotherapy (1860 of 2865; incidence: 12.7 [95% CI, 12.3-13.2]). The incidence of infection was highest in the first 3 months overall (28.2 vs 18.0 in patients who received RT plus chemotherapy compared with those who received RT monotherapy) and for definite infections (4.7 vs 3.8). The proportion of specific bacterial infections were similar among patients who received RT plus chemotherapy versus those who received RT monotherapy. Urinary tract infections were the most frequent (51.2% vs 56.2%), followed by pneumonias (24.1% vs 22.4%). Viral and fungal infections were more frequent among patients who received RT plus chemotherapy, but they were uncommon. In multivariable analyses, patients who received RT plus chemotherapy with a lymphopenia grade of 1-2 or ≥3 versus no lymphopenia at end of RT had an increased risk of bacterial infections 0 to 3 months after RT (incidence rate ratio, 1.45 [95% CI, 1.06-1.97] and 1.71 [95% CI, 1.26-2.34], respectively). Limiting to definite bacterial infections, the incidence rate ratio for lymphopenia grade ≥3 versus no lymphopenia was 2.66 (95% CI, 1.40-5.03).
The incidence of bacterial infections 0 to 3 months after RT plus chemotherapy for solid tumors was high, especially among patients with RT-induced lymphopenia grade 1-2 and ≥3.
实体瘤患者中放疗（RT）诱导淋巴细胞减少相关感染的发生率、病因及关联尚未完全阐明。
我们结合用药、微生物学及诊断数据，确定由细菌、真菌和病毒引起的可能、很可能及确诊感染。确诊感染需有诊断或微生物学阳性分离结果。我们分析了接受RT联合化疗和RT单药治疗的患者在RT开始后一年中感染的发生率及调整后的发病率比，按感染类型及RT诱导淋巴细胞减少的程度进行分析。
6334例患者中有4450例（70.3%）共经历11264次感染；1424例（22.5%）患者在RT后第一年发生2104次确诊感染。接受RT联合化疗的患者感染更频繁（3469例中的2590例；发病率：每100患者年16.5[95%置信区间{CI}，16.1 - 17.0]），而接受RT单药治疗的患者为（2865例中的1860例；发病率：12.7[95%CI，12.3 - 13.2]）。总体上感染发生率在最初3个月最高（接受RT联合化疗的患者为28.2，接受RT单药治疗的患者为18.0），确诊感染也是如此（4.7对3.8）。接受RT联合化疗与接受RT单药治疗的患者中特定细菌感染的比例相似。尿路感染最常见（分别为51.2%对56.2%），其次是肺炎（24.1%对22.4%）。病毒和真菌感染在接受RT联合化疗的患者中更常见，但并不常见。在多变量分析中，RT结束时淋巴细胞减少1 - 2级或≥3级的接受RT联合化疗的患者与RT结束时无淋巴细胞减少的患者相比，在RT后0至3个月细菌感染风险增加（发病率比分别为1.45[95%CI，1.06 - 1.97]和1.71[95%CI，1.26 - 2.34]）。限于确诊细菌感染，淋巴细胞减少≥3级与无淋巴细胞减少相比，发病率比为2.66（95%CI，1.40 - 5.03）。
实体瘤患者接受RT联合化疗后0至3个月细菌感染发生率高，尤其是RT诱导淋巴细胞减少1 - 2级和≥3级的患者。
