Tao Jun, Albert Paul S, Gottlieb Nellie, Miller Paige, Engels Eric A
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA.
California Cancer Reporting and Epidemiologic Surveillance (CalCARES) Program, University of California Davis Comprehensive Cancer Center, Sacramento, CA 95838, USA.
Cancers (Basel). 2025 Sep 4;17(17):2903. doi: 10.3390/cancers17172903.
T-cell receptor excision circles (TRECs) are measured in newborn screening programs in the United States to identify severe combined immunodeficiency (SCID). We hypothesized that relatively low TREC levels at birth, even within the normal range, could indicate compromised immunity and higher susceptibility to childhood cancers.
We conducted a case-control study using linked data from the newborn screening programs and cancer registries in California and Texas to examine the association between TREC levels and risk of childhood cancer. The study included 2196 cancer cases and 10,980 controls from California and 1186 cancer cases and 5890 controls from Texas.
In California, acute myeloid leukemia cases had significantly lower TREC levels compared with their matched controls ( = 0.0051), while in Texas, acute lymphocytic leukemia cases had significantly higher TREC levels compared with their matched controls ( = 0.0034). However, each association was not replicated in the other state, and other cancer types did not show significant differences in TREC levels between cases and controls.
We did not observe consistent associations between TREC levels at birth and childhood cancer risk. A possible explanation for the lack of more clear-cut differences in TREC levels between cases and matched controls might be the complex etiology of childhood cancers. The results underscore the need for longitudinal studies that incorporate additional immune biomarkers to understand the immunologic basis of childhood cancer development.
在美国的新生儿筛查项目中会检测T细胞受体切除环（TRECs），以识别严重联合免疫缺陷（SCID）。我们推测，出生时TREC水平相对较低，即使在正常范围内，也可能表明免疫力受损以及儿童患癌症的易感性较高。
我们利用加利福尼亚州和得克萨斯州新生儿筛查项目与癌症登记处的关联数据进行了一项病例对照研究，以检验TREC水平与儿童癌症风险之间的关联。该研究纳入了来自加利福尼亚州的2196例癌症病例和10980例对照，以及来自得克萨斯州的1186例癌症病例和5890例对照。
在加利福尼亚州，急性髓系白血病病例的TREC水平与其匹配对照相比显著较低（P = 0.0051），而在得克萨斯州，急性淋巴细胞白血病病例的TREC水平与其匹配对照相比显著较高（P = 0.0034）。然而，每种关联在另一个州均未得到重复验证，且其他癌症类型在病例与对照之间的TREC水平未显示出显著差异。
我们未观察到出生时的TREC水平与儿童癌症风险之间存在一致的关联。病例与匹配对照之间TREC水平缺乏更明确差异的一个可能解释可能是儿童癌症病因复杂。这些结果强调了开展纵向研究的必要性，该研究应纳入更多免疫生物标志物，以了解儿童癌症发生发展的免疫基础。
