Gianni Lorenzo, Cole Bernard F, Panzini Ilaria, Snyder Raymond, Holmberg Stig B, Byrne Michael, Crivellari Diana, Colleoni Marco, Aebi Stefan, Simoncini Edda, Pagani Olivia, Castiglione-Gertsch Monica, Price Karen N, Goldhirsch Aron, Coates Alan S, Ravaioli Alberto
Divisione di Oncologia e di Ematologia, Ospedale degli Infermi, and Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Azienda USL-Rimini Via Settembrini 2, Rimini, Italy.
Support Care Cancer. 2008 Jan;16(1):67-74. doi: 10.1007/s00520-007-0295-y. Epub 2007 Jul 13.
GOAL OF THE WORK: Anemia is a common side effect of chemotherapy. Limited information exists about its incidence and risk factors. The objective of this study was to evaluate the incidence of anemia and risk factors for anemia occurrence in patients with early breast cancer who received adjuvant chemotherapy.
We evaluated risk factors for anemia in pre- and post/perimenopausal patients with lymph node-positive early breast cancer treated with adjuvant chemotherapy in two randomized trials. All patients received four cycles of doxorubicin and cyclophosphamide (AC) followed by three cycles of cyclophosphamide, methotrexate, fluorouracil (CMF). Anemia incidence was related to baseline risk factors. Multivariable analysis used logistic and Cox regression.
Among the 2,215 available patients, anemia was recorded in 11% during adjuvant chemotherapy. Grade 2 and 3 anemia occurred in 4 and 1% of patients, respectively. Pretreatment hemoglobin and white blood cells (WBC) were significant predictors of anemia. Adjusted odds ratios (logistic regression) comparing highest versus lowest quartiles were 0.18 (P < 0.0001) for hemoglobin and 0.52 (P = 0.0045) for WBC. Age, surgery type, platelets, body mass index, and length of time from surgery to chemotherapy were not significant predictors. Cox regression results looking at time to anemia were similar.
Moderate or severe anemia is rare among patients treated with AC followed by CMF. Low baseline hemoglobin and WBC are associated with a higher risk of anemia.
研究目的：贫血是化疗常见的副作用。关于其发生率和危险因素的信息有限。本研究的目的是评估接受辅助化疗的早期乳腺癌患者贫血的发生率及贫血发生的危险因素。
在两项随机试验中，我们评估了接受辅助化疗的绝经前和绝经后/围绝经期淋巴结阳性早期乳腺癌患者贫血的危险因素。所有患者均接受四个周期的阿霉素和环磷酰胺（AC），随后接受三个周期的环磷酰胺、甲氨蝶呤、氟尿嘧啶（CMF）。贫血发生率与基线危险因素相关。多变量分析采用逻辑回归和Cox回归。
在2215例可用患者中，11%的患者在辅助化疗期间出现贫血。2级和3级贫血分别发生在4%和1%的患者中。治疗前血红蛋白和白细胞（WBC）是贫血的显著预测因素。逻辑回归比较最高四分位数与最低四分位数的调整比值比，血红蛋白为0.18（P<0.0001），白细胞为0.52（P=0.0045）。年龄、手术类型、血小板、体重指数以及从手术到化疗的时间长度不是显著的预测因素。Cox回归分析贫血发生时间的结果相似。
在接受AC序贯CMF治疗的患者中，中度或重度贫血很少见。低基线血红蛋白和白细胞与贫血风险较高相关。
