Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2011 Aug 15;117(16):3641-9. doi: 10.1002/cncr.25972. Epub 2011 Feb 24.
The authors evaluated the patterns of use and the risk of thromboembolic events (TEE) associated with erythropoietin-stimulating agents (ESAs) in older patients with metastatic breast cancer who were receiving chemotherapy.
The study was retrospective and used the SEER-Medicare linked database. Stage IV breast cancer patients diagnosed from 1995-2005, treated with chemotherapy, ≥66 years old, with full coverage of Medicare A and B were included. The World Health Organization's International Classification of Diseases (ICD-9) and the Healthcare Common Procedure Coding System (HCPCS) were used to identify the use of ESAs, chemotherapy, and complications of therapy. Analyses included descriptive statistics and logistic regression.
Of 2266 women, 980 (43.3%) received ESAs, and 1286 (56.7%) did not. Patients diagnosed after 1999 or who received treatment with taxanes, anthracyclines, or vinorelbine were more likely to receive ESAs. Patients receiving ESAs had higher rates of stroke (18.5% vs 15.1%, P = .031); deep-vein thrombosis (DVT; 21.3% vs 14.4%, P<.001), other/unspecified thromboembolic event (TEE; 19.8% vs 14.7%, P = .001), and any clot (31.3% vs 23.4%, P<.0001). In multivariate analysis, patients receiving ESAs had increased risk for DVT (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.05-1.75), and any clot (OR, 1.26; 95% CI, 1.02-1.57). A dose-dependent effect was evident for stroke, DVT, other TEE, and any clot.
In this cohort of patients, the use of ESAs increased the risk of TEEs, with a dose-dependent effect for stroke, DVT, other TEE, and any clot. The data show that among patients treated with chemotherapy and ESAs for metastatic breast cancer, TEEs are a common event. Therefore, caution is recommended when using these agents.
作者评估了接受化疗的转移性乳腺癌老年患者中使用促红细胞生成素刺激剂（ESA）的模式和血栓栓塞事件（TEE）的风险。
该研究为回顾性研究，使用 SEER-Medicare 数据库。纳入 1995 年至 2005 年诊断的 IV 期乳腺癌患者，接受化疗，年龄≥66 岁，医疗保险 A 类和 B 类全覆盖。使用世界卫生组织国际疾病分类（ICD-9）和医疗保健通用程序编码系统（HCPCS）来确定 ESA、化疗和治疗并发症的使用情况。分析包括描述性统计和逻辑回归。
在 2266 名女性中，980 名（43.3%）接受了 ESA，1286 名（56.7%）未接受 ESA。1999 年后诊断或接受紫杉烷、蒽环类药物或长春瑞滨治疗的患者更有可能接受 ESA。接受 ESA 的患者中风发生率更高（18.5%比 15.1%，P=.031）；深静脉血栓形成（DVT；21.3%比 14.4%，P<.001）、其他/未特指的血栓栓塞事件（TEE；19.8%比 14.7%，P=.001）和任何血栓（31.3%比 23.4%，P<.0001）。多变量分析显示，接受 ESA 的患者 DVT 的风险增加（比值比[OR]，1.36；95%置信区间[CI]，1.05-1.75）和任何血栓（OR，1.26；95%CI，1.02-1.57）。中风、DVT、其他 TEE 和任何血栓的风险呈剂量依赖性增加。
在本队列患者中，ESA 的使用增加了 TEE 的风险，与中风、DVT、其他 TEE 和任何血栓的剂量依赖性效应有关。数据表明，在接受化疗和转移性乳腺癌 ESA 治疗的患者中，TEE 是一种常见事件。因此，在使用这些药物时应谨慎。
