PEG-rhG-CSF预防乳腺癌患者化疗致发热性中性粒细胞减少症效果分析

Analysis of the Effect of PEG-rhG-CSF in Preventing Chemotherapy-induced Febrile Neutropenia in Breast Cancer Patients

目的探讨聚乙二醇化重组人粒细胞刺激因子(pegylated recombinant human granulocyte colony-stimulating factor,PEG-rhG-CSF)预防乳腺癌患者化疗致发热性中性粒细胞减少症(febrile neutropenia,FN)的临床意义。方法回顾性分析宁夏医科大学总院2019年1月至2022年3月183例乳腺癌患者接受非密集型AC-T方案(吡柔比星70 mg+环磷酰胺0.8 g+多西他赛100 mg,21 d/周期)、剂量密集型ddAC-T方案(吡柔比星85 mg+环磷酰胺1.0 g+紫杉醇290 mg,14 d/周期)及其他化疗方案(铂类、吉西他滨等)化疗后的临床资料。分析不同化疗方案中性粒细胞减少症及第一周期与后续治疗周期FN的发生情况,采用Logistic回归分析FN发生的影响因素。结果183例乳腺癌患者化疗后预防性使用PEG-rhG-CSF后中性粒细胞减少症的发生率为67.21%(123/183),Ⅲ级及以上中性粒细胞绝对计数(absolute neutrophil count,ANC)减少在ddAC-T方案中的发生率较高。第一周期FN发生率为4.37%(8/183),后续治疗周期FN发生率为1.64%(3/183)。化疗方案(OR=0.139,95%CI:0.026~0.732,P=0.020)、既往化疗(OR=34.500,95%CI:6.360~187.145,P<0.001)和既往放疗(OR=11.067,95%CI:2.278~53.768,P=0.003)是FN发生的影响因素。不良事件发生率均较低,主要为肌肉关节酸疼。结论根据不同的化疗方案以及既往放化疗史,预防性使用PEG-rhG-CSF可有效减少化疗导致的中性粒细胞减少症和FN的发生率。

Objective To explore the clinical significance of pegylated recombinant human granulocyte colony-stimulating factor(PEG-rhG-CSF)in preventing febrile neutropenia(FN)in breast cancer patients.Methods A retrospective analysis of 183 breast cancer patients who admitted to General Hospital of Ningxia Medical University from January 2019 to March 2022 to receive AC-T regimens(pirarubicin 70 mg+cyclophosphamide 0.8 g+docetaxel 100 mg,21 d/cycle),dose-intensive ddAC-T regimens(pirarubicin 85 mg+cyclophosphamide 1.0 g+paclitaxel 290 mg,14 d/cycle)and other chemotherapy regimens(platinum,gemcitabine,etc.).The occurrence of neutropenia and FN in cycle 1 and subsequent treatment cycles in different chemotherapy regimens was analyzed,and the influencing factors of FN was analyzed by Logistic regression.Results The incidence of neutropenia after prophylactic use of PEG-rhG-CSF in 183 breast cancer patients was 67.21%(123/183),of which gradeⅢand absolute neutrophil count(ANC)reduction was more common in ddAC-T regimens.The incidence of FN in the first cycle was 4.37%(8/183),the incidence of FN in subsequent cycles was 1.64%(3/183).The incidence of FN was associated with chemotherapy regimens(OR=0.139,95%CI:0.026-0.732,P=0.020),previous chemotherapy(OR=34.500,95%CI:6.360~187.145,P<0.001)and previous radiotherapy(OR=11.067,95%CI:2.278-53.768,P=0.003).The incidence of adverse events was low,mainly muscle and joint pain.Conclusion Prophylactic use of PEG-rhG-CSF depending on chemotherapy regimen and previous chemotherapy and radiotherapy is effective in reducing the incidence of chemotherapy-induced neutropenia and FN.