晚期结直肠癌患者一线FOLFOX化疗引起的骨髓抑制与预后的关系

Relationship between chemotherapy induced hematological toxicity and prognosis in advanced colorectal cancer patients undergoing first-line FOLFOX chemotherapy

目的:探讨一线应用奥沙利铂、氟尿嘧啶联合亚叶酸钙(FOLFOX)方案的晚期结直肠癌患者化疗引起的骨髓抑制(chemotherapy induced hematological toxicity,CIH)与预后的关系.方法:回顾性分析158例患者,根据CTCAE4.0标准将患者化疗引起的中性粒细胞减少(chemotherapy induced-neutropenia,CIN)分为:G0、G1、G2、G3-4组;血小板减少分为:T0、T1组;将血红蛋白(hemoglobin,Hb)减少分为贫血组(A1)和非贫血组(A0),分析中性粒细胞减少、血小板减少以及贫血与预后的关系.结果:CIN、血小板减少以及贫血是影响无进展生存期(progression-free survival,PFS)的独立预后因子.G1、G2、G3-4组较G0组进展风险降低27%、36%、29%(HR=0.73,95%C I:0.286-0.891,P=0.018;H R=0.64,95%CI:0.56-0.88,P=0.03;HR=0.71,95%CI:0.44-0.85,P<0.003);血小板减少患者较未出现血小板减少患者进展风险降低26%(HR=0.74,95%CI:0.68-0.753,P=0.015);非贫血患者较贫血患者进展风险降低18%(HR=0.823,95%CI:0.609-0.921,P=0.03).结论:化疗过程中出现CIN、血小板降低与较好的预后相关.监测并根据骨髓抑制程度及时调整化疗药物剂量,纠正贫血将有助于改善预后.

AIM： To assess whether chemotherapy induced hematological toxicity is a marker of increased progression-free survival（PFS） in patients with advanced colorectal cancer receiving first-line FOLFOX chemotherapy. METHODS ： A retrospective analysis was performed of clinical data for 158 advanced colorectal cancer patients treated at Chinese PLA General Hospital. Patient and tumor characteristics and hematological toxicity（neutropenia, anemia, and thrombocytopenia） were recorded. The relationship between hematological toxicity and prognosis was analyzed. RESULTS： Univariate analysis showed that compared with G0 neutropenia, G1/G2/G3-4 neutropenia reduced the risk of disease progression b y 2 7 %, 3 6 %, a n d 2 9 %（ H R = 0. 7 3, 9 5 % C I ： 0.286-0.891, P = 0.018; HR = 0.64, 95%CI： 0.56-0.88, P = 0.03; HR = 0.71, 95%CI： 0.44-0.85, P〈0.003）, respectively. Thrombocytopenia reduced the risk of progression by 26%（HR = 0.74, 95%CI： 0.68-0.753, P = 0.015）. In contrast, anemia during chemotherapy was significantly associated with poorer PFS（HR = 0.823, 95%CI： 0.609-0.921, P = 0.03）.CONCLUSION ： These data suggest that occurrence of neutropenia or thrombocytopenia is associated with a better prognosis. Monitoring of neutropenia during chemotherapy and corresponding drug adjustment may contribute to favorable PFS.