老年上皮性卵巢癌患者术后辅助化疗相关不良反应的危险因素及预后分析

Risk factors for hematological toxicity of adjuvant chemotherapy and prognosis analysis in elderly patients with epithelial ovarian cancer

目的探讨影响老年卵巢癌患者术后辅助化疗导致重度血液学毒性的危险因素及影响患者预后的临床危险因素。方法回顾性分析2006年1-12月于北京医院治疗的117例年龄≥60岁的卵巢上皮性癌患者,采用多因素Logistic回归分析对影响辅助化疗后发生Ⅲ~Ⅳ级血液学毒性的危险因素进行分析,采用单因素和多因素Cox比例风险回归模型分析影响患者疾病无进展生存时间的危险因素。结果本研究老年卵巢癌患者年龄(69.3±7.9)岁,67.3%(70/104)的患者术后达到满意减瘤,且有83.5%(86/103)的卵巢癌患者接受了标准方案的治疗。多因素Logistic回归分析结果显示,发生Ⅲ~Ⅳ级血液学毒性的独立危险因素为血浆白蛋白<40 g/L(OR=3.434,95%CI:1.074~10.968)和患者年龄≥75岁(OR=3.676,95%CI:1.032~13.093)。患者疾病无进展生存时间为20.4个月(95%CI:19.4~26.0)。单因素Cox回归分析结果显示,影响卵巢癌3年PFS的危险因素包括国际妇产科联盟(FIGO)分期、是否接受盆腔淋巴结清扫术、肿瘤负荷、接受输血治疗、残余肿瘤大小;多因素Cox回归分析模型结果显示,术中评估患者盆腹腔低肿瘤负荷是唯一的影响疾病3年PFS的独立危险因素(HR=2.067,95%CI:1.174~4.424,P=0.023)。结论年龄≥75岁及血浆白蛋白水平可影响卵巢癌患者术后接受辅助治疗过程中并发症的发生率,从而影响患者是否可以完成标准方案的辅助治疗并进一步影响肿瘤患者的临床结局;对于有相关不良预后因素的老年患者,应采用个体化的治疗方案,以期获得最大的治疗收益,同时减少治疗不良反应。

Objective To investigate risk factors for severe hematological toxicity of adjuvant chemotherapy and prognostic factors in elderly patients with ovarian cancer.Methods We retrospectively analyzed 117 ovarian cancer patients aged 60 years and older who underwent surgery followed by adjuvant chemotherapy between January 2006 to December 2016 at Beijing Hospital.Risk factors for grade Ⅲ〜Ⅳ hematological toxicity were assessed by using multivariate logistic regression analysis.Prognostic factors influencing progression-free survival(PFS)were evaluated by univariate and multivariate Cox regression analysis.Results The mean age of patients was(69.3±7.9)years.After surgery,67.3%patients(70/104)had a satisfactory tumor reduction.and 83.5%(86/103)received a standard treatment.Multivariable logistic regression analysis showed that risk factors for severe hematological toxidty included albumin level<40 g/L(OR=3.434,95%CI:1.074〜10.968)and age>75(OR=3.676,95%CI:1.032〜13.093).Progression-free survival for patients was 20.4 months(95%CI:19.4-26.0).Univariate Cox regression analysis showed that FIGO(the International Federation of Gynecology and Obstetrics)staging,pelvic lymphadenectomy,tumor burden,transfusion therapy and residual tumor size were risk factors influencing 3-year PFS.Multivariate Cox regression analysis showed that low tumor burden was the only independent risk factor for 3-year PFS(HR=2.067,95%CI:1.174〜4.424,P=0.023).Conclusions Age≥75 and albumin levels have effects on the incidences of complications during adjuvant chemotherapy.which in turn affect whether patients can complete standard adjuvant therapy and the clinical outcome of patients with ovarian cancer after surgery.To maximize the efficacy of treatment and reduce the side effects of adjuvant therapy,individualized treatment plan.s should be formulated for elderly patients with poor prognostic factors.