幸存的儿童期室心瘤的医疗和功能负担：加拿大安大略省的一项基于人群的研究
The medical and functional burden of surviving childhood ependymoma: A population-based study in Ontario, Canada
影响因子:2.30000
分区:医学3区 / 血液学3区 儿科3区 肿瘤学4区
发表日期:2024 Nov
作者:
Hallie Coltin, Priscila Pequeno, Ning Liu, Derek S Tsang, Sumit Gupta, Michael D Taylor, Eric Bouffet, Vijay Ramaswamy, Paul C Nathan
摘要
很少有研究表征儿童期幸存者幸存者的后期影响负担。为了解决这一差距，我们使用现实世界中的卫生服务数据在基于人群的感染瘤幸存者队列中检查了这些后遗症。在1987年至2015年之间，在加拿大安大略省的安大略省诊断出患有最新儿科癌症事件（Index Date）的年龄在1987年至2015年之间，他们在1987年至2015年之间被诊断出患有安大略省的年龄至少5年。与省级卫生服务数据联系后，比较了幸存者和对照组之间多个医疗和功能结果的累积发生率。在96个幸存者中，已照射了77.1％，9.4％的人接受了顺铂。指数后10年，幸存者的全因死亡率风险明显更高（7.1％，95％置信区间[CI]：1.0-13.3 vs. 0.3％，95％CI：0.0-1.0; p = .0002），非目标住院（45.1％，95％，95％CI：32.6-56-56-56-1.6％vs.95 vs.95 vs.95 vs.95 vs.95 vs.95 vs.95 vs.; p <.0001），中风（6.5％，95％CI：2.3-13.7 vs. 0％; p <.0001），严重的听力损失需要放大装置（7.5％，95％CI：2.7-15.7：2.7-15.7 vs. 0％; P <.0001） 5.3-10.7;需要紧急努力来改善风险分层方法，以减轻风险疾病较低的儿童对有毒疗法的暴露。防止或降低后遗症风险的干预措施对于优化幸存者长期健康至关重要。
Abstract
Few studies have characterized the burden of late effects among childhood ependymoma survivors. To address this gap, we examined these sequelae using real-world health services data in a population-based ependymoma survivor cohort.All individuals younger than 18 years diagnosed with an ependymoma in Ontario, Canada between 1987 and 2015 who had survived at least 5 years from their latest pediatric cancer event (index date) were matched 1:5 with population controls. Following linkage with provincial health services data, the cumulative incidences of multiple medical and functional outcomes between survivors and controls were compared.Among 96 survivors, 77.1% had been irradiated and 9.4% had received cisplatin. At 10 years post-index, survivors were at significantly higher risk of all-cause mortality (7.1%, 95% confidence interval [CI]: 1.0-13.3 vs. 0.3%, 95% CI: 0.0-1.0; p = .0002), non-obstetric hospitalization (45.1%, 95% CI: 32.6-56.7 vs. 10.6%, 95% CI: 7.6-14.1; p < .0001), stroke (6.5%, 95% CI: 2.3-13.7 vs. 0%; p < .0001), severe hearing loss requiring an amplification device (7.5%, 95% CI: 2.7-15.7 vs. 0%; p < .0001), receiving homecare service (27.6%, 95% CI: 18.5-37.5 vs. 7.7%, 95% CI: 5.3-10.7; p < .0001), and submitting a disability support prescription claim (24.0%, 95% CI: 14.8-34.3 vs. 5.4%, 95% CI: 3.5-7.8; p < .0001) compared to controls.Pediatric ependymoma survivors are highly vulnerable to severe late sequelae, including death, stroke, severe hearing loss, and disability. Urgent efforts are needed to improve risk-stratification approaches that mitigate exposure to toxic therapies for children with lower risk disease. Interventions to prevent or decrease the risk of developing late sequelae are critical to optimizing survivor long-term health.