Radiation Epidemiology Team, CESP, Inserm U1018, Villejuif, France.
Department of Research, Gustave Roussy, Villejuif, France.
BMC Neurol. 2024 Sep 10;24(1):335. doi: 10.1186/s12883-024-03797-8.
Childhood cancer survivors (CCS) have an increased risk of developing late chronic diseases, which can be influenced by the cancer type and its treatment. These chronic diseases can be severe and disabling, typically emerging years to decades after treatment. These deficits negatively impact quality of life, intelligence quotient, and memory. This study investigated how much the cancer type and treatment could affect the neurological hospitalisations in the French Childhood Cancer Survivors Study (FCCSS).
We included 5579 childhood cancer survivors (CCS), diagnosed with solid tumours or lymphoma between 1945 and 2000, treated before 2001 and below the age of 21 years at initial treatment. The follow-up period was from 2006 to 2018. Hospitalisation data were obtained by linkage with the National Health Data System. We calculated the relative hospitalisation rate (RHRs) and absolute excess rate (AERs). Multivariable analyses were conducted using a Generalized Linear Model (GLM) with a Poisson distribution to estimate the association between neurological hospitalisation and patient characteristics. The expected number of hospitalisations served as an offset to compare the risk for FCCSS survivors with that of the reference population. Risk estimates were reported as relative risk (RR) with 95% confidence intervals.
The hospitalisation rate for CCS was 114.2 per 10,000 person-years (PY), compared to 48.4 in the reference population. The highest hospitalisation rates were observed for epilepsy (AER = 27.1 per 10000 PY, 95%CI: 23.5-31.2 and RHR = 5.1, 95%CI 4.4-5.7). In multivariable analyses, central nervous system (CNS) tumours survivors had the highest relative risk (RR) of hospitalisation (RR = 9.4, 95%CI: 6.7-13.1) followed by neuroblastoma survivors (RR = 2.5, 95%CI: 1.7-3.7). In the whole population, survivors who received radiation to the head and neck had a significantly higher risk of hospitalisation (RR = 3.9, 95%CI: 3.3-4.7) compared to those who did not receive radiotherapy.
Head and neck irradiation was identified as a strong risk factor for hospitalisation. This underlines the importance of implementing specific neurologic surveillance programs for at-risk individuals.
儿童癌症幸存者（CCS）患晚期慢性疾病的风险增加，这些疾病可能受癌症类型和治疗的影响。这些慢性疾病可能严重且致残，通常在治疗后数年至数十年出现。这些缺陷会对生活质量、智商和记忆力产生负面影响。本研究调查了癌症类型和治疗对法国儿童癌症幸存者研究（FCCSS）中神经科住院的影响程度。
我们纳入了 5579 名儿童癌症幸存者（CCS），他们在 1945 年至 2000 年间被诊断为实体瘤或淋巴瘤，在 2001 年之前接受治疗，且在初始治疗时年龄小于 21 岁。随访期从 2006 年到 2018 年。通过与国家健康数据系统链接获取住院数据。我们计算了相对住院率（RHR）和绝对超额率（AER）。使用泊松分布的广义线性模型（GLM）进行多变量分析，以估计神经科住院与患者特征之间的关联。预期住院人数作为偏移量，用于比较 FCCSS 幸存者和参考人群的风险。风险估计以相对风险（RR）和 95%置信区间（CI）报告。
CCS 的住院率为每 10000 人年 114.2 例（PY），而参考人群为每 10000 人年 48.4 例。癫痫的住院率最高（AER=27.1/10000 PY，95%CI：23.5-31.2；RHR=5.1，95%CI：4.4-5.7）。在多变量分析中，中枢神经系统（CNS）肿瘤幸存者的住院相对风险（RR）最高（RR=9.4，95%CI：6.7-13.1），其次是神经母细胞瘤幸存者（RR=2.5，95%CI：1.7-3.7）。在整个人群中，接受头颈部放疗的幸存者住院风险显著增加（RR=3.9，95%CI：3.3-4.7），而未接受放疗的幸存者则无此风险。
头颈部放疗被确定为住院的一个重要危险因素。这强调了为高危个体实施特定神经监测计划的重要性。
