Background:Exposure to pesticides has been associated with an increased risk of developing childhood leukemia. However, the impact of pesticides on childhood leukemia survival has not been examined. We investigated the associations between residential pesticide use during key developmental periods and 5-year survival in children treated for acute lymphoblastic leukemia (ALL).Methods:Residential use of insecticides, herbicides, rodenticides, and flea control products from preconception up to 12 months prior to diagnosis and sociodemographic characteristics were collected via parental interview among 837 children diagnosed with ALL between 1995 and 2008 in California, USA. Data on clinical features were abstracted from medical records. Vital status was obtained through linkage to the National Death Index (NDI) up to 2020. Cox proportional hazards regression models were used to estimate hazard ratios (HRs), adjusting for sociodemographic factors and clinical risk group.Results:A total of 108 children with ALL (~13%) died within 5 years of diagnosis. Exposure to any pesticides pre- and/or postnatally was slightly higher among deceased compared to alive children (95.4% vs. 91.5%;p= 0.23), while use of rodenticides was significantly higher in children who died (25.0%) vs. those who survived (15.5%;p= 0.02). In fully adjusted models, exposure to rodenticides was associated with an increased risk of mortality (HR 1.70; 95% confidence interval (CI) 1.08–2.64;p= 0.02), especially when the child was exposed during pregnancy (HR 1.90; 95% CI 1.15–3.16;p= 0.01) and possibly 12 months before diagnosis (HR 1.60; 95% CI 0.98–2.61;p= 0.06). Increased hazards of death were also observed with other types of pesticides during pregnancy, but those associations were not statistically significant.Conclusions:This study is the first to report reduced survival among children with ALL previously exposed to rodenticides, particularly during pregnancy, underscoring the need to further evaluate mechanisms by which environmental exposures during key developmental stages may later impact cancer outcomes.
背景：农药暴露与儿童白血病发病风险增加相关，但其对儿童白血病生存期的影响尚未得到研究。本研究探讨了关键发育期家庭农药使用与急性淋巴细胞白血病（ALL）患儿五年生存率之间的关联。 方法：通过家长访谈收集了1995年至2008年间美国加利福尼亚州837名ALL确诊患儿的数据，包括从孕前至诊断前12个月期间家庭使用杀虫剂、除草剂、灭鼠剂和跳蚤控制产品的情况及社会人口学特征。临床特征数据从医疗记录中提取。通过关联国家死亡索引（NDI）获取截至2020年的生存状态。采用Cox比例风险回归模型估计风险比（HR），并校正社会人口学因素和临床风险分组。 结果：共有108名ALL患儿（约13%）在确诊后5年内死亡。与存活患儿相比，死亡患儿在产前和/或产后接触任何农药的比例略高（95.4% vs. 91.5%；p=0.23），而灭鼠剂使用率在死亡患儿中显著更高（25.0% vs. 15.5%；p=0.02）。在完全校正模型中，灭鼠剂暴露与死亡风险增加相关（HR 1.70；95%置信区间（CI）1.08–2.64；p=0.02），特别是在孕期暴露（HR 1.90；95% CI 1.15–3.16；p=0.01）及可能在诊断前12个月暴露（HR 1.60；95% CI 0.98–2.61；p=0.06）的情况下。孕期接触其他类型农药也观察到死亡风险增加，但这些关联未达到统计学显著性。 结论：本研究首次报道了既往暴露于灭鼠剂（尤其是孕期暴露）的ALL患儿生存率降低，强调需要进一步评估关键发育阶段环境暴露影响癌症预后的潜在机制。
肿瘤(癌症)患者之家