Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA.
Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
J Clin Oncol. 2023 Jan 10;41(2):364-372. doi: 10.1200/JCO.22.00230. Epub 2022 Jul 25.
Infections pose a significant risk during therapy for childhood cancer. However, little is known about the risk of infection in long-term survivors of childhood cancer.
We performed a retrospective observational study of children and adolescents born in Washington State diagnosed with cancer before age 20 years and who survived at least 5 years after diagnosis. Survivors were categorized as having a hematologic or nonhematologic malignancy and were matched to individuals without cancer in the state birth records by birth year and sex with a comparator:survivor ratio of 10:1. The primary outcome was incidence of any infection associated with a hospitalization using diagnostic codes from state hospital discharge records. Incidence was reported as a rate (IR) per 1,000 person-years. Multivariate Poisson regression was used to calculate incidence rate ratios (IRR) for cancer survivors versus comparators.
On the basis of 382 infection events among 3,152 survivors and 771 events among 31,519 comparators, the IR of all hospitalized infections starting 5 years after cancer diagnosis was 12.6 (95% CI, 11.4 to 13.9) and 2.4 (95% CI, 2.3 to 2.6), respectively, with an IRR 5.1 (95% CI, 4.5 to 5.8). The survivor IR during the 5- to 10-year (18.1, 95% CI, 15.9 to 20.5) and > 10-year postcancer diagnosis (8.3, 95% CI, 7.0 to 9.7) periods remained greater than comparison group IRs for the same time periods (2.3, 95% CI, 2.1 to 2.6 and 2.5, 95% CI, 2.3 to 2.8, respectively). When potentially vaccine-preventable infections were evaluated, survivors had a greater risk of infection relative to comparators (IRR, 13.1; 95% CI, 7.2 to 23.9).
Infectious complications continue to affect survivors of childhood cancer many years after initial diagnosis. Future studies are needed to better understand immune reconstitution to determine specific factors that may mitigate this risk.
在儿童癌症的治疗过程中，感染是一个重大的风险因素。然而，对于儿童癌症长期幸存者的感染风险，我们知之甚少。
我们对在华盛顿州出生、20 岁前被诊断患有癌症且在诊断后至少存活 5 年的儿童和青少年进行了回顾性观察性研究。幸存者分为血液系统或非血液系统恶性肿瘤，并按出生年份和性别与州出生记录中的癌症个体进行匹配，匹配比例为 10:1。主要结局是使用州医院出院记录中的诊断代码确定任何与住院相关的感染的发生率。感染发生率以每 1000 人年的感染率（IR）表示。采用多变量泊松回归计算癌症幸存者与对照组的感染发生率比（IRR）。
根据 382 例感染事件（3152 例幸存者中）和 771 例感染事件（31519 例对照组中），癌症诊断后 5 年开始的所有住院感染的发生率为 12.6（95%CI，11.4 至 13.9）和 2.4（95%CI，2.3 至 2.6），感染发生率比为 5.1（95%CI，4.5 至 5.8）。5 至 10 年（18.1，95%CI，15.9 至 20.5）和 > 10 年癌症诊断后（8.3，95%CI，7.0 至 9.7）的幸存者发生率仍高于同一时期的对照组发生率（分别为 2.3，95%CI，2.1 至 2.6 和 2.5，95%CI，2.3 至 2.8）。当评估潜在的疫苗可预防感染时，与对照组相比，幸存者感染的风险更高（IRR，13.1；95%CI，7.2 至 23.9）。
感染并发症在儿童癌症初始诊断多年后仍继续影响幸存者。未来的研究需要更好地了解免疫重建，以确定可能减轻这种风险的具体因素。
