早期乳腺癌患者化疗骨髓抑制与药物疗效关系的分析

Analysis of the relationship between chemotherapy-induced myelotoxicity and clinical efficacy in patients with early breast cancer

目的分析乳腺癌患者化疗骨髓抑制与预后的关系。方法检索Pub Med,EMbase和Cochrane数据库,进行系统性评价和Meta分析,使用固定效应模型或随机效应模型合并风险比(HR)和95%置信区间(95%CI)。结果本研究纳入9篇研究,共计9103名早期乳腺癌患者。相比于未出现骨髓抑制的患者,骨髓抑制的患者无病生存期(DFS)(HR:0.65,95%CI:0.54~0.79)显著延长,但总生存期(OS)延长(HR:0.69,95%CI:0.47~1.03)不显著。但重度骨髓抑制的患者在OS(HR:0.84,95%CI:0.75~0.95)和DFS(HR:0.67,95%CI:0.49~0.92)均显著获益。结论化疗诱导的血液学毒性可以作为早期乳腺癌的有效的标志之一,有助于判断药效和制定治疗决策。

Objective To evaluate the prognostic value of chemotherapy-induced myelotoxicity and analyze their clinical implications. Methods Pooled hazard ratios,95% CI（ confidence interval）,were estimated for end points using the fixed or random effects statistical model. Results The analysis included 9 studies with 9103 patients. Compared with myelotoxicity-free patients,myelotoxicity indicates a better prognosis on disease free survival（ DFS）（ HR： 0. 65,95CI： 0. 54-0. 79） but not in overall survival（ OS）（ HR： 0. 69,95% CI： 0. 47-1. 03）. Severe myelotoxicity indicates a better OS（ HR： 0. 84,95% CI： 0. 75-0. 95）and DFS（ HR： 0. 67,95% CI： 0. 49-0. 92） in contrast to myelotoxicity-free patients. Conclusion Chemotherapy-induced myelotoxicity is a prognostic factor in early stage breast cancer. It is helpful for predicting prognosis as well as treatment planning.