Zhou Otto, Harila Arja, Hovén Emma, Lönnerblad Malin
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Int J Cancer. 2025 Apr 1;156(7):1347-1357. doi: 10.1002/ijc.35231. Epub 2024 Oct 19.
Acute lymphoblastic leukemia (ALL) constitutes approximately 25% of pediatric cancers, and with contemporary protocols, the 5-year survival rate is over 90%. Despite improved survival, neurocognitive impairments from treatment raise concerns. This registry study aimed to explore the impact of ALL treatment on educational outcomes from school year nine in Swedish children. A population-based cohort of 503 children diagnosed with ALL from 1990 to 2010 was identified from the Swedish Childhood Cancer Registry and matched with five controls each. Assessed variables were delayed graduation, high school eligibility, total merit value, school grades in Swedish, English, mathematics, and physical education, and results in national tests. Analyses were performed between cases and controls and by sex, age at diagnosis, and risk group. Our results showed that, compared to controls, cases had higher odds for delayed graduation, poorer results in physical education, and higher rates of absence in national tests in English and mathematics. Children in the standard-risk group (treated with first-line chemotherapy only) exhibited similar results to matched controls whereas children in the high-risk group (treated with cranial irradiation, hematological stem cell transplantation, or/and for ALL relapse and thus likely received also radiotherapy) had lower total merit value compared to controls. We conclude that Swedish children diagnosed with ALL between the years 1990-2010 mainly exhibited comparable educational outcomes to controls, although children in the high-risk group had lower results. These findings highlight the importance of evaluating especially children with high-risk ALL in order to identify those requiring educational support and for designing targeted interventions.
急性淋巴细胞白血病（ALL）约占儿童癌症的25%，采用现代治疗方案后，5年生存率超过90%。尽管生存率有所提高，但治疗引起的神经认知障碍令人担忧。这项登记研究旨在探讨ALL治疗对瑞典儿童九年级学业成绩的影响。从瑞典儿童癌症登记处确定了1990年至2010年期间确诊为ALL的503名儿童的人群队列，并为每名儿童匹配了5名对照。评估的变量包括毕业延迟、高中入学资格、总绩点、瑞典语、英语、数学和体育学科的学校成绩以及国家考试成绩。对病例组和对照组之间以及按性别、诊断时年龄和风险组进行了分析。我们的结果表明，与对照组相比，病例组毕业延迟的几率更高，体育成绩更差，英语和数学国家考试的缺考率更高。标准风险组（仅接受一线化疗）的儿童表现与匹配的对照组相似，而高风险组（接受颅脑照射、血液干细胞移植或/和ALL复发治疗，因此可能也接受了放疗）的儿童总绩点低于对照组。我们得出结论，1990 - 2010年间确诊为ALL的瑞典儿童的学业成绩总体上与对照组相当，尽管高风险组的儿童成绩较低。这些发现凸显了特别评估高风险ALL儿童的重要性，以便识别那些需要教育支持的儿童并设计针对性的干预措施。
