Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA 19104, USA.
Gynecol Oncol. 2011 Mar;120(3):464-9. doi: 10.1016/j.ygyno.2010.11.009. Epub 2010 Dec 17.
Bevacizumab is a generally well-tolerated drug, but bevacizumab-associated gastrointestinal perforations (BAP) occur in 0 to 15% of patients with ovarian carcinoma. Our goal was to evaluate the clinical predictors of BAP in order to identify factors, which may preclude patients from receiving treatment.
We conducted a review of patients with recurrent epithelial ovarian carcinoma treated with bevacizumab between 2006 and 2009. Demographic and treatment data were collected for statistical analysis.
Eighty-two patients were identified; perforation occurred in 8 (9.76%). Among patients with perforation, a significantly higher incidence of prior bowel surgeries (p=0.0008) and prior bowel obstruction or ileus (p<0.0001) were found compared to non-perforated patients. The median age at onset of bevacizumab in the perforated group was 3 years younger (60 vs. 63 years, p=0.61). The incidence of thromboembolic events, GI comorbidities, number of prior chemotherapies, and body mass index were similar between the groups. None of the patients in the perforated group developed grade 3 or 4 hypertension, compared to a 32.4% incidence among the non-perforated patients (p=0.09). Upon multivariate analysis, when controlled for age greater or less than 60, prior bowel surgery, obstruction/ileus, and grade 3 or 4 hypertension, only the presence of obstruction/ileus was noted to be a significant predictor of perforation (p=0.04).
Predicting BAP remains a challenge. Bowel obstruction or ileus appears to be associated with increased risk of BAP.
贝伐单抗通常具有良好的耐受性，但卵巢癌患者中有 0 至 15%会发生贝伐单抗相关的胃肠道穿孔（BAP）。我们的目标是评估 BAP 的临床预测因子，以确定可能使患者无法接受治疗的因素。
我们对 2006 年至 2009 年间接受贝伐单抗治疗的复发性上皮性卵巢癌患者进行了回顾性研究。收集了人口统计学和治疗数据进行统计分析。
共确定了 82 例患者；穿孔发生在 8 例（9.76%）中。与未穿孔患者相比，穿孔患者中既往肠手术（p=0.0008）和既往肠阻塞或肠梗阻（p<0.0001）的发生率明显更高。穿孔组开始使用贝伐单抗时的中位年龄小 3 岁（60 岁 vs. 63 岁，p=0.61）。穿孔组血栓栓塞事件、胃肠道合并症、既往化疗次数和体重指数的发生率在两组之间相似。与未穿孔组 32.4%的发生率相比，穿孔组无一例发生 3 级或 4 级高血压（p=0.09）。多变量分析时，在控制年龄大于或小于 60 岁、既往肠手术、梗阻/肠梗阻以及 3 级或 4 级高血压的情况下，只有梗阻/肠梗阻的存在被认为是穿孔的显著预测因子（p=0.04）。
预测 BAP 仍然具有挑战性。肠阻塞或肠梗阻似乎与 BAP 风险增加有关。
