儿童肿瘤患者铂类诱导耳毒性的发生率、严重程度及危险因素：一项多中心回顾性研究
Incidence, severity, and risk factors of platinum-induced ototoxicity in pediatric oncology patients: A multi-center retrospective study.
文献信息
| PMID | 42913140 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Min Young Shin |
| 作者单位 | Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. |
| 期刊 | International journal of pediatric otorhinolaryngology |
| SCI 分区 | Q2 |
| IF | 1.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 以铂类为基础的化疗药物，尤其是顺铂和卡铂，常用于儿童肿瘤治疗，但常与耳毒性相关。本研究旨在评估韩国儿童肿瘤患者中铂类诱导耳毒性的发生率、严重程度及危险因素。
方法： 我们在韩国三家三级医院开展了一项回顾性队列研究，回顾了2004年至2024年间接受顺铂或卡铂治疗的314例儿童肿瘤患者的病历。听力功能通过听力学评估进行评价，包括纯音测听、听性脑干反应（ABR）和畸变产物耳声发射（DPOAE）。耳毒性定义为Chang分级≥2a或ABR/DPOAE上等效的阈值偏移。
结果： 146例患者（46.5%）被识别出耳毒性。听力损失主要累及高频（≥4 kHz），与铂类诱导的感音神经性听力损失一致。男性、髓母细胞瘤诊断以及卡铂治疗均分别与风险增加显著相关。11岁前确诊的患者在所有频率上均表现出显著更差的阈值（p < 0.05）。接受放疗的患者在低频表现出显著更差的阈值（p < 0.001），尽管总放射剂量和铂类治疗持续时间与听力损失并无独立相关性。
结论： 近半数接受铂类化疗的儿童患者发生了耳毒性。较年轻年龄、男性、卡铂暴露以及头颈部放疗与更差的听力结局相关，凸显了对高危患者进行标准化听力监测的必要性。
英文摘要
OBJECTIVE: Platinum-based chemotherapeutic agents, particularly cisplatin and carboplatin, are commonly used in pediatric oncology but are frequently associated with ototoxicity. This study aimed to evaluate the incidence, severity, and risk factors of platinum-induced ototoxicity in Korean pediatric cancer patients.
METHODS: We conducted a retrospective cohort study across three tertiary hospitals in South Korea, reviewing the medical records of 314 pediatric oncology patients treated with cisplatin or carboplatin between 2004 and 2024. Hearing function was assessed using audiologic evaluations, including pure-tone audiometry, auditory brainstem response (ABR), and distortion product otoacoustic emission (DPOAE). Ototoxicity was defined as a Chang grade of ≥2a or equivalent threshold shifts on ABR/DPOAE.
RESULTS: Ototoxicity was identified in 146 patients (46.5%). Hearing loss predominantly affected high frequencies (≥4 kHz), consistent with platinum-induced sensorineural hearing loss. Male sex, a diagnosis of medulloblastoma, and treatment with carboplatin were each significantly associated with increased risk. Patients diagnosed before age 11 exhibited significantly worse thresholds across all frequencies (p < 0.05). Patients who received radiotherapy showed significantly worse thresholds at low frequencies (p < 0.001), although total radiation dose and platinum-treatment duration were not independently correlated with hearing loss.
CONCLUSIONS: Nearly half of pediatric patients treated with platinum chemotherapy developed ototoxicity. Younger age, male sex, carboplatin exposure, and head and neck radiotherapy were associated with poorer hearing outcomes, highlighting the need for standardized hearing surveillance in high-risk patients.