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Paranasal sinusitis at the initiation of chemotherapy is a risk factor for invasive fungal disease in children and adolescents with cancer

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Abstract

Background

The impact of paranasal sinusitis on the clinical outcome of patients with cancer remains unknown. The aim of this study was to determine whether paranasal sinusitis at the initiation of chemotherapy (SAI) affects the development of infectious complications in children and adolescents with cancer.

Methods

A retrospective cohort analysis of patients aged 0-20 years with cancer who received chemotherapy was performed. SAI was defined as the presence of a fluid level or mucosal swelling or total opacity on sinus computed tomography examination before the initiation of chemotherapy. The primary outcome measures were the incidence of bacteremia, septic shock, and invasive fungal disease (IFD, including proven, probable, and possible cases).

Results

SAI was observed in 57 (44%) of 130 enrolled patients. There were no significant differences in age, sex, and disease distribution between the patients with SAI (SAI group) and those without (non-SAI group). There was no significant difference in the 1-year cumulative incidence of bacteremia or septic shock after treatment initiation between the two groups (bacteremia, SAI group 33% vs. non-SAI group 35%, P = 0.53; septic shock, SAI group 4% vs. non-SAI group 4%, P = 0.87). The 1-year cumulative incidence of IFD was higher in the SAI group than in the non-SAI group (22% vs. 6%, P = 0.012). Cumulative incidence analysis after inverse probability of treatment weighting adjustment showed that the SAI group was more likely to develop IFD (HR: 3.5, 95% CI: 1.1-11.2, P = 0.033).

Conclusions

Our findings suggest that patients with SAI may be at higher risk for IFD during chemotherapy.

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Data and materials availability

The datasets analyzed during the current study available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Higashi-Sapporo 6-6, Shiroishi-ku, Sapporo, Hokkaido, 003-0006, Japan

    Kenji Kishimoto, Ryoji Kobayashi, Daiki Hori, Satoru Matsushima, Masato Yanagi, Hirozumi Sano, Daisuke Suzuki & Kunihiko Kobayashi

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  1. Kenji Kishimoto
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  2. Ryoji Kobayashi
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  7. Daisuke Suzuki
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  8. Kunihiko Kobayashi
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Contributions

Kenji Kishimoto and Ryoji Kobayashi contributed to study conception and design. Kenji Kishimoto, Daiki Hori, Satoru Matsushima, Masato Yanagi, Hirozumi Sano, and Daisuke Suzuki collected the data. Kenji Kishimoto and Ryoji Kobayashi performed the analysis and interpretation of data. Kenji Kishimoto drafted the manuscript. Ryoji Kobayashi and Kunihiko Kobayashi edited and made critical revision to the manuscript. All the authors contributed to the final manuscript.

Corresponding author

Correspondence to Kenji Kishimoto.

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Ethics approval

This study was approved by the Institutional Review Board of Sapporo Hokuyu Hospital.

Conflicts of interest

The authors declare that they have no conflict of interest.

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Patient enrollment process. CT, computed tomography (PNG 10 kb)

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Kishimoto, K., Kobayashi, R., Hori, D. et al. Paranasal sinusitis at the initiation of chemotherapy is a risk factor for invasive fungal disease in children and adolescents with cancer. Support Care Cancer 29, 5847–5852 (2021). https://doi.org/10.1007/s00520-021-06143-7

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