Shayne Michelle, Crawford Jeffrey, Dale David C, Culakova Eva, Lyman Gary H
James P. Wilmot Cancer Center, University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA.
Breast Cancer Res Treat. 2006 Dec;100(3):255-62. doi: 10.1007/s10549-006-9254-4. Epub 2006 May 17.
This retrospective study was undertaken to define risk factors for reductions in dose intensity of adjuvant chemotherapy in women with early stage breast cancer (ESBC).
A nationwide survey of 190 community oncology practices was conducted between 1998 and 2002 with data collected retrospectively on 3,707 patients treated with adjuvant chemotherapy for ESBC. End points included reductions in dose intensity, delivered relative dose intensity (RDI) <85%, and the incidence of chemotherapy dose delays >/=7 days and dose reduction >/=15%. Demographic and clinical characteristics, incidence of febrile neutropenia (FN), and patterns of use of granulocyte colony-stimulating factor (G-CSF) were also assessed.
Average RDI for all regimens was 88%, with 30% of patients receiving <85% of standard for their regimen. Seventeen percent of the reduction in average RDI was planned from the start of therapy, and 13% was unplanned. In univariate analysis, significant predictors of reduced RDI were: age >/=65 years (41%, P < 0.001), body surface area (BSA) >2 m(2) (37%, P < 0.001), negative lymph nodes (33%, P < 0.001), FN (36%, P = 0.013), and comorbidities (40%, P = 0.013), particularly renal disease (86%, P = 0.004). Dose reduction was less with prophylactic G-CSF (24%, P < 0.001). In multivariate analysis, significant independent predictors of reduced RDI included: advanced age, greater BSA, comorbidities, anthracycline-based regimens, a 28-day schedule and FN, while primary G-CSF prophylaxis was associated with a significant reduction in risk.
A significant proportion of patients with potentially curable ESBC continue to experience planned and unplanned reductions in RDI.
本回顾性研究旨在确定早期乳腺癌（ESBC）女性辅助化疗剂量强度降低的风险因素。
1998年至2002年期间对190个社区肿瘤医疗实践进行了全国性调查，回顾性收集了3707例接受ESBC辅助化疗患者的数据。终点包括剂量强度降低、相对剂量强度（RDI）<85%以及化疗剂量延迟≥7天和剂量降低≥15%的发生率。还评估了人口统计学和临床特征、发热性中性粒细胞减少症（FN）的发生率以及粒细胞集落刺激因子（G-CSF）的使用模式。
所有方案的平均RDI为88%，30%的患者接受的剂量低于其方案标准的85%。平均RDI降低的17%是从治疗开始就计划好的，13%是未计划的。在单因素分析中，RDI降低的显著预测因素为：年龄≥65岁（41%，P<0.001）、体表面积（BSA）>2 m²（37%，P<0.001）、阴性淋巴结（33%，P<0.001）、FN（36%，P = 0.013）和合并症（40%，P = 0.013），尤其是肾病（86%，P = 0.004）。预防性使用G-CSF时剂量降低较少（24%，P<0.001）。在多因素分析中，RDI降低的显著独立预测因素包括：高龄、较大的BSA、合并症、基于蒽环类药物的方案、28天疗程和FN，而主要的G-CSF预防与风险显著降低相关。
相当一部分潜在可治愈的ESBC患者继续经历计划内和计划外的RDI降低。
