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

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.%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.