Schwenkglenks Matthias, Jackisch Christian, Constenla Manuel, Kerger Joseph N, Paridaens Robert, Auerbach Leo, Bosly André, Pettengell Ruth, Szucs Thomas D, Leonard Robert
European Center of Pharmaceutical Medicine, University of Basel, University Hospital, Basel, Switzerland.
Support Care Cancer. 2006 Sep;14(9):901-9. doi: 10.1007/s00520-006-0034-9. Epub 2006 Apr 19.
The aims of this study were to assess chemotherapy treatment characteristics, neutropenic event (NE) occurrence and related risk factors in breast cancer patients in Western Europe.
Six retrospective audits of breast cancer chemotherapy were combined into a dataset of 2,860 individuals. NEs were defined as neutropenia-related hospitalisation, dose reduction > or = 15% or dose delay > or = 7 days. Summation dose intensity (SDI) was calculated to compare different types of chemotherapy regimens on a single scale. Risk factors of NE occurrence and of low relative dose intensity (RDI) < or = 85% were identified by multiple logistic regression.
Patient populations were comparable between audits. Until 1998, cyclophosphamide, methotrexate and fluorouracil regimens were most frequently used, but thereafter, anthracycline-based regimens were most common. NEs occurred in 20% of the patients and low RDI in 16%. NE occurrence predicted low RDI and was associated with higher age, bigger body surface area, lower body mass index, regimen type, more chemotherapy cycles planned, normal to high SDI, concomitant radiotherapy and year of treatment. First cycle NE occurrence predicted NEs from cycle 2 onwards. A risk score using age, SDI, number of planned chemotherapy cycles and concomitant radiotherapy differentiated patients with increasing NE risk (9-37%). An alternative score version not using concomitant radiotherapy performed moderately less well.
NEs occurred frequently in this combined dataset and they affected treatment delivery. Identifying patients at high NE risk enables targeted prophylaxis and may avoid dose limitations.
本研究旨在评估西欧乳腺癌患者的化疗治疗特征、中性粒细胞减少事件（NE）的发生情况及相关危险因素。
六项乳腺癌化疗回顾性审计合并成一个包含2860名个体的数据集。NE被定义为与中性粒细胞减少相关的住院、剂量减少≥15%或剂量延迟≥7天。计算总剂量强度（SDI）以在单一尺度上比较不同类型的化疗方案。通过多因素逻辑回归确定NE发生和相对低剂量强度（RDI）<或=85%的危险因素。
各次审计的患者群体具有可比性。直到1998年，环磷酰胺、甲氨蝶呤和氟尿嘧啶方案使用最为频繁，但此后，以蒽环类为基础的方案最为常见。20%的患者发生NE，16%的患者RDI较低。NE的发生预示着RDI较低，并且与年龄较大、体表面积较大、体重指数较低、方案类型、计划的化疗周期较多、SDI正常至高、同步放疗以及治疗年份相关。第一个周期发生NE预示着从第二个周期开始会出现NE。使用年龄、SDI、计划的化疗周期数和同步放疗的风险评分可区分NE风险增加（9 - 37%）的患者。不使用同步放疗的另一个评分版本表现稍差。
在这个合并的数据集中NE频繁发生，并且影响治疗实施。识别NE高风险患者能够进行有针对性的预防，并可能避免剂量限制。
