Lambert Laura A, Armstrong Terri S, Lee J Jack, Liu Suyu, Katz Matthew H G, Eng Cathy, Wolff Robert A, Tortorice Melissa L, Tansey Pier, Gonzalez-Moreno Santiago, Lambert Donald H, Mansfield Paul F
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2009 Aug;16(8):2181-7. doi: 10.1245/s10434-009-0523-4. Epub 2009 May 28.
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are considered the standard of care for patients with peritoneal dissemination of appendiceal cancer and are increasingly being evaluated for use in patients with carcinomatosis from colon cancer. Mitomycin C (MMC) is one of the most frequently used HIPEC agents in the management of peritoneal-based gastrointestinal malignancies. This study analyzes the incidence and risk factors for developing neutropenia following MMC-HIPEC combined with CRS.
All patients undergoing CRS and MMC-HIPEC for appendiceal cancer between January 1993 and October 2006 were retrospectively reviewed. Logistic regression was used to identify risk factors for the development of neutropenia, defined as an absolute neutrophil count (ANC) <1,000/mm(3).
One hundred and twenty MMC-HIPEC were performed in 117 patients with appendiceal cancer. The incidence of neutropenia was 39%. Neutropenia occurred in 57.6% of female and 21.3% of male patients (p < 0.0001). Female gender and MMC dose per body surface area (BSA) were independent risk factors for neutropenia on multivariable logistic regression [odds ratio (OR) of neutropenia in females = 3.58 (95% confidence interval, CI: 1.52, 8.43); OR for 5 unit (mg/m(2)) increase in MMC dose per BSA = 3.37 (95% CI: 1.72, 6.63)]. Neutropenia did not increase the risk of mortality, postoperative infection or length of hospital stay.
Neutropenia is a frequent complication associated with MMC-HIPEC. Female sex and MMC dose per BSA are independent risk factors for neutropenia. These differences must be considered in the management of patients undergoing MMC-HIPEC to minimize the toxicity of the procedure.
细胞减灭术（CRS）和热灌注化疗（HIPEC）被认为是阑尾癌腹膜播散患者的标准治疗方法，并且越来越多地被评估用于结肠癌性腹膜炎患者。丝裂霉素C（MMC）是腹膜型胃肠道恶性肿瘤管理中最常用的HIPEC药物之一。本研究分析了MMC-HIPEC联合CRS后发生中性粒细胞减少的发生率及危险因素。
回顾性分析1993年1月至2006年10月期间所有因阑尾癌接受CRS和MMC-HIPEC治疗的患者。采用逻辑回归分析确定发生中性粒细胞减少的危险因素，中性粒细胞减少定义为绝对中性粒细胞计数（ANC）<1000/mm³。
117例阑尾癌患者共进行了120次MMC-HIPEC治疗。中性粒细胞减少的发生率为39%。女性患者中性粒细胞减少发生率为57.6%，男性患者为21.3%（p<0.0001）。多变量逻辑回归分析显示，女性性别和每体表面积（BSA）MMC剂量是中性粒细胞减少的独立危险因素[女性中性粒细胞减少的比值比（OR）=3.58（95%置信区间，CI：1.52，8.43）；每BSA的MMC剂量增加5单位（mg/m²）的OR=3.37（95%CI：1.72，6.63）]。中性粒细胞减少并未增加死亡风险、术后感染风险或住院时间。
中性粒细胞减少是与MMC-HIPEC相关的常见并发症。女性性别和每BSA的MMC剂量是中性粒细胞减少的独立危险因素。在接受MMC-HIPEC治疗的患者管理中必须考虑这些差异，以尽量减少该治疗方法的毒性。
