Kasteler Rahel, Otth Maria, Halbeisen Florian S, Mader Luzius, Singer Florian, Rössler Jochen, von der Weid Nicolas X, Ansari Marc, Kuehni Claudia E
Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Pediatric Hematology-Oncology Center, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland.
Pediatr Pulmonol. 2024 Jan;59(1):169-180. doi: 10.1002/ppul.26738. Epub 2023 Oct 31.
Childhood cancer survivors are at risk for pulmonary morbidity due to exposure to lung-toxic treatments, including specific chemotherapeutics, radiotherapy, and surgery. Longitudinal data on lung function and its change over time are scarce. We investigated lung function trajectories in survivors over time and the association with lung-toxic treatments.
This retrospective, multicenter cohort study included Swiss survivors diagnosed between 1990 and 2013 and exposed to lung-toxic chemotherapeutics or thoracic radiotherapy. Pulmonary function tests (PFTs), including forced expiration volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC, total lung capacity, and diffusion capacity of the lung for carbon monoxide, were obtained from hospital charts. We calculated z-scores and percentage predicted, described lung function over time, and determined risk factors for change in FEV1 and FVC using multivariable linear regression.
We included 790 PFTs from 183 survivors, with a median age of 12 years at diagnosis and 5.5 years of follow-up. Most common diagnosis was lymphoma (55%). Half (49%) of survivors had at least one abnormal pulmonary function parameter, mainly restrictive (22%). Trajectories of FEV1 and FVC started at z-scores of -1.5 at diagnosis and remained low throughout follow-up. Survivors treated with thoracic surgery started particularly low, with an FEV1 of -1.08 z-scores (-2.02 to -0.15) and an FVC of -1.42 z-scores (-2.27 to -0.57) compared to those without surgery.
Reduced pulmonary function was frequent but mainly of mild to moderate severity. Nevertheless, more research and long-term surveillance of this vulnerable population is needed.
儿童癌症幸存者因接触肺部毒性治疗，包括特定化疗、放疗和手术，存在发生肺部疾病的风险。关于肺功能及其随时间变化的纵向数据稀缺。我们调查了幸存者随时间的肺功能轨迹以及与肺部毒性治疗的关联。
这项回顾性多中心队列研究纳入了1990年至2013年间诊断出且接触过肺部毒性化疗或胸部放疗的瑞士幸存者。从医院病历中获取肺功能测试（PFT）结果，包括第1秒用力呼气量（FEV1）、用力肺活量（FVC）、FEV1/FVC、肺总量和肺一氧化碳弥散量。我们计算了z分数和预测百分比，描述了随时间变化的肺功能，并使用多变量线性回归确定FEV1和FVC变化的风险因素。
我们纳入了183名幸存者的790次PFT结果，诊断时的中位年龄为12岁，随访时间为5.5年。最常见的诊断是淋巴瘤（55%）。一半（49%）的幸存者至少有一项肺功能参数异常，主要为限制性异常（22%）。FEV1和FVC轨迹在诊断时的z分数为-1.5，在整个随访期间一直较低。与未接受手术的幸存者相比，接受胸外科手术的幸存者起始值特别低，FEV1为-1.08 z分数（-2.02至-0.15），FVC为-1.42 z分数（-2.27至-0.57）。
肺功能降低很常见，但主要为轻度至中度严重程度。尽管如此，仍需要对这一脆弱人群进行更多研究和长期监测。
