结直肠癌患者接受含伊立替康方案化疗后出现迟发性腹泻的临床特征及相关因素分析

Clinical characteristics and risk factors of delayed diarrhea following irinotecan-based chemotherapies in colorectal cancer patients

目的分析结直肠癌患者接受含伊立替康的化疗方案后,发生迟发性腹泻的临床特征及相关因素。方法回顾性纳入2018年1月至2023年6月于北京大学第三医院接受抗肿瘤治疗的结直肠癌患者,分析病历记录的全部包含伊立替康的化疗线,收集有关临床资料,依据病程中是否发生过迟发性腹泻,将患者分为腹泻组和无腹泻组;依据本轮化疗是否发生迟发性腹泻,分为合并腹泻的化疗组和无腹泻的化疗组,每1轮化疗视作1例次数据。统计迟发性腹泻的发生率及其临床特征。采用多因素logistic回归模型分析迟发性腹泻发生的相关因素。结果共纳入215例患者。腹泻组104例,男57例,女47例,年龄23~83(58±12)岁;无腹泻组111例,男73例,女38例,年龄32~83(58±10)岁。所有患者总计接受过271例次包含伊立替康的化疗线,合并迟发性腹泻的化疗组有118例次(43.5%),其中22例次(18.6%)为≥3级的严重腹泻。87例次(73.7%)腹泻事件发生于第1周期化疗后,首次出现腹泻的中位时间[M(Q_(1),Q_(3))]为化疗后第4(3,5)天。迟发性腹泻导致41例次(34.7%)化疗线后续延期或药物减量。化疗时年龄>65岁(OR=1.96,95%CI:1.13~3.38)、方案含有三种化疗药物(OR=3.48,95%CI:1.38~8.82)的患者发生任意级别腹泻的风险较高,既往有结直肠癌肝转移切除术史(OR=0.51,95%CI:0.27~0.95)的患者发生任意级别腹泻的风险较低(均P<0.05)。结论伊立替康相关迟发性腹泻在我国结直肠癌患者中发生率较高,多出现在首次用药后,且部分患者较为严重。化疗时年龄>65岁、方案含有三种化疗药物的患者发生任意级别腹泻的风险较高,既往有结直肠癌肝转移切除术史的患者发生任意级别腹泻的风险较低。

Objective To investigate the clinical characteristics and risk factors of delayed diarrhea following irinotecan-based chemotherapies in colorectal cancer patients.Methods Patients with colorectal cancer undergoing antitumor treatment at Peking University Third Hospital from January 2018 to June 2023 were retrospectively included.All lines of chemotherapies containing irinotecan were analyzed,and related clinical information was collected.According to whether delayed diarrhea occured in the course of the disease,the patients were divided diarrhea group and non-diarrhea group;According to whether delayed diarrhea occurred in the current round of chemotherapy,the patients were divided into chemotherapy group with diarrhea and chemotherapy group without diarrhea,and each round of chemotherapy was regarded as one case data.The incidence and clinical features of delayed diarrhea were analyzed.The multivariate logistic regression model was used to analyze risk factors for the occurrence of delayed diarrhea.Results A total of 215 patients were included.There were 104 cases in the diarrhea group,57 males and 47 females,aged 23 to 83(58±12)years.There were 111 cases without diarrhea,73 males and 38 females,aged 32 to 83(58±10)years.All patients received a total of 271 chemotherapy lines including irinotecan.In the chemotherapy group with delayed diarrhea,there were 118 cases(43.5%),of which 22 cases(18.6%)were severe diarrhea of grade 3 or above.Eighty-seven cases(73.7%)of diarrhea occurred after the first cycle of treatment,with the onset time[M(Q_(1),Q_(3))]on day 4(3,5)after chemotherapy.Delayed diarrhea resulted in 41 cases(34.7%)of delayed chemotherapy or reduced drug dosage.Patients over 65 years old(OR=1.96,95%CI:1.13-3.38),at the time of chemotherapy and with three chemotherapeutic drugs(OR=3.48,95%CI:1.38-8.82)have a higher risk of diarrhea of any grade,while patients with a previous history of colorectal cancer liver metastasis resection(OR=0.51,95%CI:0.27-0.95)have a lower risk of diarrhea of any grade(all P<0.05).Conclusions Delayed diarrhea associated with irinotecan has a high incidence in Chinese patients with colorectal cancer,often occurring after initial drug administration,and some patients experienced severe episodes of diarrhea.Patients who are over 65 years old at the time of chemotherapy and whose regimen contains three chemotherapeutic drugs have a higher risk of diarrhea of any grade,while patients with a previous history of colorectal cancer liver metastasis resection have a lower risk of diarrhea of any grade.