Dept. of Obstetrics & Gynecology, University of California, Irvine Medical Center, Orange, CA 92868, USA.
Gynecologic Oncology Group Statistical & Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
Gynecol Oncol. 2014 Jun;133(3):439-45. doi: 10.1016/j.ygyno.2014.03.013. Epub 2014 Mar 20.
To determine whether chemotherapy-induced neutropenia (C-iN) is associated with improved survival in a population of primary advanced ovarian cancer and peritoneal carcinoma patients treated with a carboplatin plus paclitaxel chemotherapy backbone.
A post-hoc exploratory analysis of Gynecologic Oncology Group (GOG) protocol 182 was performed. Landmark analysis was conducted on all patients with progression-free survival >18weeks from the time of study entry. Neutropenia was defined as the absolute neutrophil count <1000mm(3). The occurrence of C-iN was analyzed according to demographic, clinicopathologic, and therapeutic intent, including age, body surface area, and treatment arm. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The Cox proportional hazards model was used to evaluate independent prognostic factors and to estimate their effects on PFS and OS.
Neutropenic data was available for 3447 patients. Neutropenic (n=3196) and non-neutropenic groups (n=251) were similar in demographic and clinicopathologic characteristics. Neutropenic patients experienced significantly improved survival compared to non-neutropenic patients with the adjusted hazard ratio (HR) for death being 0.86 (95% confidence interval 0.74-0.99; p=0.041). There was no survival benefit associated with any of the treatment arms among patients with C-iN.
These data suggest that C-iN may represent a clinical biomarker associated with a survival advantage for patients with untreated advanced ovarian cancer. The absence of C-iN may indicate under-dosing and ultimately attenuated anti-neoplastic effect in vulnerable populations.
确定在接受卡铂联合紫杉醇化疗方案治疗的原发性晚期卵巢癌和腹膜癌患者人群中，化疗引起的中性粒细胞减少症（C-iN）是否与生存改善相关。
对妇科肿瘤学组（GOG）方案 182 进行了事后探索性分析。对所有从研究入组开始无进展生存时间>18 周的患者进行了无进展生存的里程碑分析。中性粒细胞减少症定义为绝对中性粒细胞计数<1000mm3。根据人口统计学、临床病理和治疗目的（包括年龄、体表面积和治疗臂）分析 C-iN 的发生情况。使用 Kaplan-Meier 方法估计无进展生存（PFS）和总生存（OS）。Cox 比例风险模型用于评估独立预后因素，并估计它们对 PFS 和 OS 的影响。
3447 名患者的中性粒细胞减少数据可用。中性粒细胞减少组（n=3196）和非中性粒细胞减少组（n=251）在人口统计学和临床病理特征方面相似。中性粒细胞减少患者的生存明显优于非中性粒细胞减少患者，调整后的死亡风险比（HR）为 0.86（95%置信区间 0.74-0.99；p=0.041）。在有 C-iN 的患者中，任何治疗臂都没有与生存获益相关。
这些数据表明，C-iN 可能代表一种与未经治疗的晚期卵巢癌患者生存优势相关的临床生物标志物。C-iN 的缺失可能表明在脆弱人群中剂量不足，最终减弱抗肿瘤作用。
