高危乳腺癌辅助化疗后白细胞减少的危险因素及其与预后的相关性研究

Analysis on Risk Factors of Adjuvant Chemotherapy-induced Leucopenia in High Risk Breast Cancer and its Relationship with the Prognosis

目的评价高危乳腺癌术后化疗相关性白细胞减少与其预后之间的关系。方法对106例高危乳腺癌患者采用FAC-D方案行术后辅助化疗,根据化疗相关性白细胞减少程度进行分组:无白细胞减少的患者为对照组;轻度(Ⅰ～Ⅱ度)减少为观察1组、重度(Ⅲ～Ⅳ度)减少为观察2组,比较三组的无病生存率和总生存率,并分析影响化疗相关性白细胞减少的危险因素及与预后的关系。结果白细胞轻度(Ⅰ～Ⅱ度)减少的发生率为51.0%,白细胞重度(Ⅲ～Ⅳ度)减少的发生率为26.5%。对照组、观察1组与观察2组的无病生存率分别为56.5%、78.8%和67.9%,总生存率分别为70.8%、88.9%和82.1%,观察1组无病生存率和总生存率明显高于对照组和观察2组。化疗相关性白细胞减少的程度与患者无病生存期呈正相关趋势。转移淋巴结数目、病灶大小、基础白细胞数、胃肠道反应是化疗相关性白细胞减少的危险因素,而患者年龄、伤口愈合情况、ER状态并不影响其发生。结论影响高危乳腺癌化疗相关性白细胞减少发生的危险因素主要包括转移淋巴结数目、病灶大小、基础白细胞数、胃肠道反应,化疗相关性白细胞减少,这些因素可能成为乳腺癌化疗患者的预后的预测指标,值得进一步研究。

Objective To examine the relationship between the adjuvant chemotherapy-induced leucopenia （CIL） and curative effects in high risk breast cancer patients. Methods 106 patients were treated with FAC-D regimen. According to the degree of CIL, the patients were classified into three groups：no reduction of leucopenia as control group;Ⅰ-Ⅱleucopenia as the observation group 1;Ⅲ-Ⅳleucopenia as the observation group 2. The disease-free survival （DFS） and overall survival （OS） in three groups were compared and the relationship between CIL risk factors and chemotherapy curative effects were analyzed. Results CIL in observation group 1 and observation group 2 was 51.0%and 26.5%respectively. The disease-free survival rate was 56.5%, 78.8%and 67.9%respectively for the control group, observation group 1 and observation group 2. The overall survival rate was 70.8%, 88.9%and 82.1%respectively in the control group, observation group 1 and observa-tion group 2. Compared with the other two groups, DFS and OS were obviously higher in observation group 1 （P〈0.05）. It was positively correlated between the degree of CIL and the DFS and OS （P〈0.05）. It was showed that the number and size of transfer lymph node, foundation of white blood cells, gastrointestinal reaction were the risk factors of chemotherapy related leucopenia in breast cancer;while the age, wound healing, ER state had nothing to do with it. Conclusion The risk factors of chemotherapy induced leucopenia in breast cancer include the number and size of transfer lymph node, foundation of white blood cells, gastrointestinal reaction. Chemotherapy-related leucopenia may be taken as an indicator for prognosis of patients with breast cancer after chemotherapy.