肿瘤患者化疗后严重不良反应相关因素分析

Risk factors associated with serious adverse reactions to cancer chemotherapy

目的探讨实体肿瘤患者化疗后严重不良反应的影响因素。方法纳入145例实体肿瘤患者,记录患者化疗前的年龄、性别、体重指数、体能状态评分(ECOG-PS)、肿瘤类型、临床分期、根据MAX2判定的化疗方案级别、剂量强度等因素及化疗后不良反应,采用单因素及多因素分析研究严重不良反应的影响因素。结果单因素分析结果显示,肿瘤类型、MAX2化疗方案级别、血红蛋白水平对3~4级血液学毒性的发生率有影响(P﹤0.05);多因素分析结果显示,非消化道肿瘤和血红蛋白水平下降是3~4级血液学毒性发生的独立危险因素(P﹤0.05)。对于非血液学毒性而言,年龄、ECOG-PS评分、肿瘤类型、体质指数(BMI)、白蛋白水平、血红蛋白水平、肌酐清除率、MAX2化疗方案级别、剂量强度对3~4级非血液学毒性的发生率均无影响(P﹥0.05)。结论实体肿瘤患者化疗前需评估耐受性,对于肺癌、肉瘤或头颈部肿瘤等非消化道肿瘤、MAX2化疗方案级别2级、存在贫血的患者,应警惕严重血液学不良反应的发生,并给予预防治疗。

Objective To explore the risk factors associated with serious adverse reactions to chemotherapy in patients with solid tumor. Method 145 patients with solid tumor were included in this study. Patient characteristics prior to chemotherapy including age, sex, body mass index（BMI）, ECOG performance status（ECOG-PS）, tumor type, clinical stage, chemotherapy regimen based on MAX2, chemotherapy dose intensity and adverse reactions to chemotherapy were recorded. Factors influencing serious adverse reactions were studied by univariate analysis and multivariate analysis. Re Result The univariate analysis showed that tumor type, MAX2 chemotherapy regimen and hemoglobin level had an effect on the incidence of grade 3 to 4 hematologic toxicity（P〈0.05）; in multivariate analysis, non-digestive tract tumors and low hemoglobin levels were independent risk factors of grade 3 to 4 hematologic toxicity（P〈0.05）. For non-hematologic toxicity, no significant correlations were found between the incidence of grade 3 to 4 non-hematologic toxicity and factors of age, ECOG-PS score, tumor type, BMI, albumin level, hemoglobin level, creatinine clearance, MAX2 chemotherapy regimen and dose intensity（P〉0.05）. Conclusion In patients with solid tumor, the assessment of tolerance to treatment should be performed before chemotherapy. For patients with non-digestive tract tumors（such as lung cancer, sarcoma and head neck cancer）, level 2 MAX2 chemotherapy regimen and anemia, preventive treatment should be given to prevent serious hematological adverse reactions.