E A Huis In 't Veld, I A Van Assche, K Van Calsteren, T Salaets, M G Slieker, E Cardonick, M van Grotel, M J Halaska, C Fontana, R Fruscio, J Lemiere, M van Gerwen, E M van Dijk-Lokkart, C L Lejeune, H van Tinteren, L Mertens, V Tomek, S Posthouwer, J Voigt, M M van den Heuvel-Eibrink, L Lagae, F Amant
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Standardized assessments were used, and associations between neurocognitive outcomes and covariates were examined using one-way and multivariable ANOVA. Further analyses examined the need for extra support and the impact of chemotherapy exposure on puberty onset.</p><p><strong>Findings: </strong>Of 166 children, 122 children were exposed to chemotherapy, 17 to surgery alone, 14 to radiotherapy, one to trastuzumab, one to rituximab, and 21 to no treatment. Cardiac function was within normal ranges, with a median ejection fraction of 56.7% (z-score: -1.6) and two cases showing mild systolic dysfunction (EF <50%). Neurocognitive outcomes, including intelligence, memory, and attention, were also within normal limits. However, 9 children had lower verbal memory scores linked to chemotherapy exposure (β = -0.52, p = .044). 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引用次数: 0
摘要
背景：缺乏证据表明产前暴露于母体癌症及其治疗对青少年神经认知、心脏和身体健康的长期影响。方法：在一项多中心队列研究中，12岁和/或15岁的儿童，产前暴露于母体癌症（治疗），接受临床、超声心动图和神经认知评估。采用标准化评估，并使用单因素和多因素方差分析检查神经认知结果和协变量之间的关联。进一步的分析检查了额外支持的需求和化疗暴露对青春期发病的影响。结果：在166名儿童中，122名儿童接受化疗，17名接受单独手术，14名接受放疗，1名接受曲妥珠单抗，1名接受利妥昔单抗，21名未接受治疗。心功能在正常范围内，中位射血分数为56.7% (z-score: -1.6)， 2例出现轻度收缩功能障碍(EF解释：总体而言，未发现产前暴露于母亲癌症及其治疗的青少年的神经认知、心脏或身体发育出现明显中断。观察到的脆弱性，如较低的言语记忆和注意力得分，主要与早产和孕产妇死亡有关，而不是与孕产妇癌症或其治疗有关。建议进行持续监测，以了解成年后的长期结果。资助：Kom Op Tegen Kanker， KWF Kankerbestrijding, Stichting Tegen Kanker, Fonds Wetenschappelijk Onderzoek，合作项目。
LONG-TERM DEVELOPMENT OF 12- AND 15-YEAR-OLD OFFSPRING AFTER MATERNAL CANCER DIAGNOSIS DURING PREGNANCY: A PROSPECTIVE MULTICENTRE COHORT STUDY.
Background: Evidence is lacking on the long-term effects of prenatal exposure to maternal cancer and its treatment on adolescent neurocognitive, cardiac, and physical health.
Methods: In a multicentre cohort study, children aged 12 and/or 15 years, prenatally exposed to maternal cancer (treatment), underwent clinical, echocardiographic, and neurocognitive evaluations. Standardized assessments were used, and associations between neurocognitive outcomes and covariates were examined using one-way and multivariable ANOVA. Further analyses examined the need for extra support and the impact of chemotherapy exposure on puberty onset.
Findings: Of 166 children, 122 children were exposed to chemotherapy, 17 to surgery alone, 14 to radiotherapy, one to trastuzumab, one to rituximab, and 21 to no treatment. Cardiac function was within normal ranges, with a median ejection fraction of 56.7% (z-score: -1.6) and two cases showing mild systolic dysfunction (EF <50%). Neurocognitive outcomes, including intelligence, memory, and attention, were also within normal limits. However, 9 children had lower verbal memory scores linked to chemotherapy exposure (β = -0.52, p = .044). Visuospatial memory was negatively correlated with maternal death (β = -0.55, p = .019), and attention was influenced by prematurity (β = 0.034 per gestational week, p = .020) and male sex (β = -0.17, p = .024). Extra support was needed in 21 children, primarily associated with lower intelligence, attention, and executive function scores, as well as prematurity. Pubertal development was within standard ranges, with no significant associations found between chemotherapy exposure and puberty onset.
Interpretation: Overall, no significant disruptions were found in the neurocognitive, cardiac, or physical development of adolescents prenatally exposed to maternal cancer and its treatment. Observed vulnerabilities, such as lower verbal memory and attention scores, were primarily linked to prematurity and maternal death rather than maternal cancer or its treatment. Ongoing monitoring is recommended to understand long-term outcomes into adulthood.
Funding: Kom Op Tegen Kanker, KWF Kankerbestrijding, Stichting Tegen Kanker, Fonds Wetenschappelijk Onderzoek, Cooperatio Program.
期刊介绍：
Annals of Oncology, the official journal of the European Society for Medical Oncology and the Japanese Society of Medical Oncology, offers rapid and efficient peer-reviewed publications on innovative cancer treatments and translational research in oncology and precision medicine.
The journal primarily focuses on areas such as systemic anticancer therapy, with a specific emphasis on molecular targeted agents and new immune therapies. We also welcome randomized trials, including negative results, as well as top-level guidelines. Additionally, we encourage submissions in emerging fields that are crucial to personalized medicine, such as molecular pathology, bioinformatics, modern statistics, and biotechnologies. Manuscripts related to radiotherapy, surgery, and pediatrics will be considered if they demonstrate a clear interaction with any of the aforementioned fields or if they present groundbreaking findings.
Our international editorial board comprises renowned experts who are leaders in their respective fields. Through Annals of Oncology, we strive to provide the most effective communication on the dynamic and ever-evolving global oncology landscape.
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