肥胖对澳大利亚卵巢癌研究（AOCS）中晚期浆液性卵巢癌女性化疗剂量的影响。
Impact of obesity on chemotherapy dosing for women with advanced stage serous ovarian cancer in the Australian Ovarian Cancer Study (AOCS).
机构信息
Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
Gynaecological Cancers Group, QIMR Berghofer Institute of Medical Research, Brisbane, Queensland, Australia.
出版信息
Gynecol Oncol. 2014 Apr;133(1):16-22. doi: 10.1016/j.ygyno.2014.01.030.
OBJECTIVES
Obesity is an increasing health problem that is reported to influence chemotherapy dosing. The extent to which this occurs and whether this affects outcomes in ovarian cancer was unclear. To describe chemotherapy dosing practices in normal, overweight and obese patients treated for FIGO Stage III/IV serous ovarian cancer in the Australian Ovarian Cancer Study (AOCS). To evaluate the relationship between body mass index (BMI), dose intensity of chemotherapy received, overall survival (OS) and progression free survival (PFS).
METHODS
Patient characteristics including age, height, weight, FIGO stage, serum creatinine, primary chemotherapy received and outcome data were extracted from medical records and entered into the AOCS database. Outcomes were analysed against BMI and relative dose intensity (RDI) received, based on calculations derived from a standard regimen (carboplatin AUC 5 and paclitaxel 175mg/m(2)).
RESULTS
333 women were included in the analysis. 27% were overweight and 21% were obese. In cycle 1 66% of obese patients received carboplatin doses more than 5% below their optimal calculated dose, and 32% received sub-optimal paclitaxel doses, compared to 25% and 13% of normal weight patients respectively. Obese women were more likely to have received <85% RDI for carboplatin compared to normal weight women (p<0.001). BMI group and RDI of carboplatin and paclitaxel were not predictors of OS. Women who received less than 85% RDI for carboplatin had a worse PFS (univariate analysis, median PFS 11 versus 15 months; p=0.04). There was no significant association between RDI and OS or PFS in multivariate analysis.
CONCLUSIONS
Obesity is common in ovarian cancer patients, and commonly results in lower chemotherapy dosing than recommended. Analysis of chemotherapy dosing from this study suggests that reduced dose intensity of carboplatin, which was more common in obese women, may impact on PFS in patients with advanced serous ovarian cancer.
目的
肥胖是一个日益严重的健康问题，据报道会影响化疗剂量。肥胖对化疗剂量的影响程度以及是否会影响卵巢癌患者的结局尚不清楚。本研究旨在描述澳大利亚卵巢癌研究（AOCS）中接受FIGO Ⅲ/Ⅳ期浆液性卵巢癌治疗的正常体重、超重和肥胖患者的化疗剂量方案，并评估体重指数（BMI）、接受的化疗剂量强度与总生存（OS）和无进展生存（PFS）之间的关系。
方法
从病历中提取患者特征，包括年龄、身高、体重、FIGO 分期、血清肌酐、初始化疗方案及结局数据，并录入 AOCS 数据库。根据标准方案（卡铂 AUC5 和紫杉醇 175mg/m²）计算得出的剂量，分析 BMI 和相对剂量强度（RDI）与结局的关系。
结果
共纳入 333 例患者。27%为超重，21%为肥胖。第 1 周期，66%的肥胖患者接受的卡铂剂量比计算得出的最佳剂量低 5%以上，32%接受的紫杉醇剂量低于标准剂量，而正常体重患者分别为 25%和 13%。与正常体重患者相比，肥胖患者接受的卡铂 RDI<85%的可能性更高（p<0.001）。BMI 组和卡铂及紫杉醇的 RDI 不是 OS 的预测因素。卡铂 RDI<85%的患者 PFS 更差（单因素分析，中位 PFS 11 个月 vs. 15 个月；p=0.04）。多因素分析中，RDI 与 OS 或 PFS 均无显著相关性。
结论
肥胖在卵巢癌患者中很常见，常导致化疗剂量低于推荐剂量。本研究中对化疗剂量的分析表明，肥胖女性中更常见的卡铂剂量强度降低可能会影响晚期浆液性卵巢癌患者的 PFS。
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