晚期结直肠癌患者一线应用FOLFOX方案化疗引起中性粒细胞减少的预后价值

doi:10.3969/j.issn.1671-167X.2017.04.022

北京大学学报(医学版) ›› 2017, Vol. 49 ›› Issue (4): 669-674. doi: 10.3969/j.issn.1671-167X.2017.04.022

晚期结直肠癌患者一线应用FOLFOX方案化疗引起中性粒细胞减少的预后价值

陈杨，王艳荣，石燕，戴广海△

（中国人民解放军总医院肿瘤内二科，北京， 100853）

出版日期:2017-08-18 发布日期:2017-08-18
通讯作者: 戴广海 E-mail: daigh60@sohu.com
基金资助:
吴阶平医学基金会临床科研专项基金(320.6750.11076)资助

Prognostic value of chemotherapy-induced neutropenia in metastatic colon cancer patients undergoing first-line chemotherapy with FOLFOX

CHEN Yang, WANG Yan-rong, SHI Yan, DAI Guang-hai△

(Medical Oncology of Department 2, Chinese PLA General Hospital, Beijing, 100853, China)

Online:2017-08-18 Published:2017-08-18
Contact: DAI Guang-hai E-mail: daigh60@sohu.com
Supported by:
Supported by WU Jieping Medical Foundation for Clinical Research (320.6750.11076)

摘要/Abstract

摘要： 目的：探讨一线应用奥沙利铂联合氟尿嘧啶、亚叶酸钙（FOLFOX）方案化疗的晚期结直肠癌患者中性粒细胞减少（chemotherapy-induced neutropenia,CIN）与预后的关系。方法：回顾性分析一线应用FOLFOX方案化疗的晚期结直肠癌患者158例,根据患者化疗后3周期内最低中性粒细胞数与化疗前比较分为CIN程度大的组（较化疗前降低大于等于1.0×109）和程度小的组（较化疗前CIN降低小于1.0×109）以及无明显变化组，分析其与预后的关系。结果：CIN降低程度是患者预后指标无进展生存（progression free survival, PFS）和总生存（overall survival, OS）的独立影响因素。根据COX多因素回归分析，CIN程度大的组(large，L)较无明显变化组(absent，A)死亡风险降低31%(HR=0.687,95% CI: 0.381~0.812,P=0.016)；CIN程度小的组(slight，S)较无明显变化组死亡风险降低18%(HR=0.817,95% CI: 0.527~0.939,P=0.027)。无明显变化组 (A)患者的中位OS为12.9个月，CIN程度少的组(S)患者的中位OS为17.3个月，CIN程度大的组(L)患者的中位OS为20.8个月(S vs. L, P=0.018; L vs. A, P=0.009; S vs. A, P=0.011)。结论：CIN程度是晚期结直肠癌化疗判断预后的独立影响因素,监测并根据CIN程度及时调整化疗药物剂量，或许有助于改善预后。

关键词: 结直肠肿瘤, 预后, 抗肿瘤联合化疗方案, 中性粒细胞减少

Abstract: Objective： To evaluate the prognostic value of chemotherapy-induced neutropenia (CIN) in metastatic colon cancer undergoing first-line chemotherapy with FOLFOX. Methods: Data were collected from a retrospective survey of 158 consecutive metastatic colon cancer patients who had undergone FOLFOX chemotherapy. The clinicopathological characteristics and chemotherapy features of the patients were analyzed as potential prognostic factors. The patients were stratified by the decreased level of CIN to three groups: large decreased level (the number of neutrophil decreased more than 1.0×109 compared with that before chemotherapy),small decreased level (the number of neutrophil decreased less than 1.0×109 compared with that before chemotherapy) and the absence of neutropenia. Results: According to a multivariate COX model, decreased level of CIN was a independent prognostic factor of colon cancer patients. Hazard ratios of death were 0.687 (95% CI: 0.381-0.812, P=0.016) for patients with large decreased level of CIN and 0.817 (95% CI: 0.527-0.939,P=0.027) for those with small decreased level of CIN compared with those of absent neutropenia patients. Median overall survival was 12.9 months (95% CI: 10.4-15.4) for patients without neutropenia (A) compared with 20.8 months (95% CI: 18.3-23.1) for patients with large-decreased level of CIN (L) and with 17.3 months (95% CI: 16.2-18.8) for those with small-decreased level of CIN (S vs. L, P=0.018; L vs. A, P=0.009; S vs. A, P=0.011). Conclusion: Our results demonstrate that the decreased level of CIN is a predictor of prognosis in patients with metastatic colon cancer undergoing FOLFOX chemotherapy. Patients who have experienced large decreased level of CIN haave longer survival time than small decreased level of CIN or absent patients. To monitor CIN decreased level timely and adjust chemotherapy drug dose may help improve the prognosis.

Key words: Colorectal neoplasms, Prognosis, Antineoplastic combined chemotherapy protocols, Neutropenia

中图分类号:

R735.3

陈杨，王艳荣，石燕，戴广海. 晚期结直肠癌患者一线应用FOLFOX方案化疗引起中性粒细胞减少的预后价值[J]. 北京大学学报(医学版), 2017, 49(4): 669-674.

CHEN Yang, WANG Yan-rong, SHI Yan, DAI Guang-hai. Prognostic value of chemotherapy-induced neutropenia in metastatic colon cancer patients undergoing first-line chemotherapy with FOLFOX[J]. Journal of Peking University(Health Sciences), 2017, 49(4): 669-674.

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晚期结直肠癌患者一线应用FOLFOX方案化疗引起中性粒细胞减少的预后价值

Prognostic value of chemotherapy-induced neutropenia in metastatic colon cancer patients undergoing first-line chemotherapy with FOLFOX

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