结直肠癌和非小细胞肺癌患者发生贝伐珠单抗相关蛋白尿事件的危险因素分析

Risk factors for bevacizumab-related proteinuria in patients with colorectal cancer and non-small cell lung cancer

目的探讨接受贝伐珠单抗(BEV)治疗的转移性结直肠癌(CRC)和非小细胞肺癌(NSCLC)患者发生蛋白尿事件的危险因素。方法收集2016年9月至2017年12月在复旦大学附属中山医院接受BEV联合标准化疗方案治疗的CRC和NSCLC患者的病历资料进行回顾性分析。结果纳入分析的患者共252例,男性166例(65.9%),女性86例(34.1%);年龄23~81岁,平均(58±11)岁;CRC 151例,NSCLC 101例;BEV中位疗程为9(1~30)个。应用BEV期间蛋白尿总体发生率为23.8%(60/252)。发生蛋白尿的风险随年龄增长而增高,≥65岁患者发生蛋白尿的风险最大[比值比(OR)=3.769,95%置信区间(CI):2.060~6.895,P<0.001];BEV疗程≥7个者发生蛋白尿的风险明显增加,以疗程≥10个者风险最大(OR=2.878,95%CI:1.583~5.234,P<0.001);合并高血压病者BEV相关蛋白尿的发生风险增加(OR=2.189,95%CI:1.214~3.945,P=0.008)。结论BEV相关蛋白尿事件的主要危险因素有高龄(≥65岁)、合并高血压病和用药超过7个疗程,对存在危险因素的患者在BEV治疗期间应加强尿常规和肾功能监测。

ObjectiveTo explore risk factors of proteinuria events in bevacizumab(BEV)-treated patients with metastatic colorectal cancer (CRC) and non-small cell lung cancer (NSCLC).MethodsThe medical records of patients with CRC and NSCLC who received BEV combined with standard chemotherapy regimen in Zhongshan Hospital Affiliated to Fudan University from September 2016 to December 2017 were collected and analyzed retrospectively.ResultsA total of 252 patients were enrolled into the study, including 166 males (65.9%) and 86 females (34.1%), aged 23-81 years with the average age of (58±11) years. One hundred and fifty-one patients were diagnosed with CRC, 101 patients were diagnosed with NSCLC, and the median cycle of the BEV treatment was 9 (1-30). The incidence of all-grade proteinuria during BEV treatment was 23.8%(60/252). The risk of proteinuria occurrence increased with aging, and patients ≥ 65 years old had the highest risk (OR=3.769, 95%CI: 2.060-6.895, P<0.001). The risk of proteinuria was also significantly increased in patients having received ≥7 cycles of BEV treatment, and the highest risk existed in patients having received ≥10 cycles of BEV treatment (OR=3.769, 95%CI: 2.060-6.895, P<0.001). The risk of BEV-associated proteinuria increased in CRC or NSCLC patients with hypertension (OR=2.189, 95%CI: 1.214-3.945, P=0.008).ConclusionsThe main risk factors of BEV-related proteinuria events in patients with CRC or NSCLC were aging (≥65 years old), complicated with hypertension, and receiving ≥7 cycles of BEV treatment. Urine routine and renal function monitoring should be strengthened in patients with above risk factors during their BEV treatments.