Department of Clinical Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan.
Cancer Chemother Pharmacol. 2011 Aug;68(2):301-7. doi: 10.1007/s00280-010-1487-6. Epub 2010 Oct 20.
We performed a systematic review and meta-analysis to determine the impact of neutropenia or leukopenia experienced during chemotherapy on survival.
Eligible studies included prospective or retrospective analyses that evaluated neutropenia or leukopenia as a prognostic factor for overall survival or disease-free survival. Statistical analyses were conducted to calculate a summary hazard ratio and 95% confidence interval (CI) using random-effects or fixed-effects models based on the heterogeneity of the included studies.
Thirteen trials were selected for the meta-analysis, with a total of 9,528 patients. The hazard ratio of death was 0.69 (95% CI, 0.64-0.75) for patients with higher-grade neutropenia or leukopenia compared to patients with lower-grade or lack of cytopenia. Our analysis was also stratified by statistical method (any statistical method to decrease lead-time bias; time-varying analysis or landmark analysis), but no differences were observed.
Our results indicate that neutropenia or leukopenia experienced during chemotherapy is associated with improved survival in patients with advanced cancer or hematological malignancies undergoing chemotherapy. Future prospective analyses designed to investigate the potential impact of chemotherapy dose adjustment coupled with monitoring of neutropenia or leukopenia on survival are warranted.
我们进行了一项系统评价和荟萃分析，以确定化疗期间中性粒细胞减少或白细胞减少对生存的影响。
合格的研究包括前瞻性或回顾性分析，评估中性粒细胞减少或白细胞减少作为总生存或无病生存的预后因素。根据纳入研究的异质性，采用随机效应或固定效应模型进行统计分析，计算汇总风险比和 95%置信区间（CI）。
共有 13 项试验被纳入荟萃分析，总计 9528 名患者。与低级别或无细胞减少症患者相比，高级别中性粒细胞减少或白细胞减少患者的死亡风险比为 0.69（95%CI，0.64-0.75）。我们的分析还按统计方法（任何减少领先时间偏倚的统计方法；时变分析或标志分析）进行分层，但未观察到差异。
我们的结果表明，化疗期间中性粒细胞减少或白细胞减少与接受化疗的晚期癌症或血液恶性肿瘤患者的生存改善相关。未来需要进行前瞻性分析，以研究化疗剂量调整结合中性粒细胞减少或白细胞减少监测对生存的潜在影响。
