Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
Center for Observational Research, Amgen, Inc., Thousand Oaks.
Ann Oncol. 2014 Sep;25(9):1821-1829. doi: 10.1093/annonc/mdu203. Epub 2014 Jun 10.
Chemotherapy-induced febrile neutropenia (FN) is a clinically important complication that affects patient outcome by delaying chemotherapy doses or reducing dose intensity. Risk of FN depends on chemotherapy- and patient-level factors. We sought to determine the effects of chronic comorbidities on risk of FN.
We conducted a cohort study to examine the association between a variety of chronic comorbidities and risk of FN in patients diagnosed with six types of cancer (non-Hodgkin lymphoma and breast, colorectal, lung, ovary, and gastric cancer) from 2000 to 2009 who were treated with chemotherapy at Kaiser Permanente Southern California, a large managed care organization. We excluded those patients who received primary prophylactic granulocyte colony-stimulating factor. History of comorbidities and FN events were identified using electronic medical records. Cox models adjusting for propensity score, stratified by cancer type, were used to determine the association between comorbid conditions and FN. Models that additionally adjusted for cancer stage, baseline neutrophil count, chemotherapy regimen, and dose reduction were also evaluated.
A total of 19 160 patients with mean age of 60 years were included; 963 (5.0%) developed FN in the first chemotherapy cycle. Chronic obstructive pulmonary disease [hazard ratio (HR) = 1.30 (1.07-1.57)], congestive heart failure [HR = 1.43 (1.00-1.98)], HIV infection [HR = 3.40 (1.90-5.63)], autoimmune disease [HR = 2.01 (1.10-3.33)], peptic ulcer disease [HR = 1.57 (1.05-2.26)], renal disease [HR = 1.60 (1.21-2.09)], and thyroid disorder [HR = 1.32 (1.06-1.64)] were all associated with a significantly increased FN risk.
These results provide evidence that history of several chronic comorbidities increases risk of FN, which should be considered when managing patients during chemotherapy.
化疗引起的发热性中性粒细胞减少症（FN）是一种影响患者预后的临床重要并发症，会导致化疗剂量延迟或减少剂量强度。FN 的风险取决于化疗和患者的因素。我们旨在确定慢性合并症对 FN 风险的影响。
我们进行了一项队列研究，以检查在 2000 年至 2009 年间接受化疗治疗的六种癌症（非霍奇金淋巴瘤和乳腺癌、结直肠癌、肺癌、卵巢癌和胃癌）患者中，各种慢性合并症与 FN 风险之间的关联。我们排除了接受初级预防性粒细胞集落刺激因子治疗的患者。使用电子病历确定合并症和 FN 事件的病史。使用 Cox 模型调整倾向评分，按癌症类型分层，以确定合并症与 FN 之间的关联。还评估了另外调整癌症分期、基线中性粒细胞计数、化疗方案和剂量减少的模型。
共纳入 19160 例平均年龄为 60 岁的患者；1963 例（5.0%）在第一个化疗周期中发生 FN。慢性阻塞性肺疾病[风险比（HR）=1.30（1.07-1.57）]、充血性心力衰竭[HR=1.43（1.00-1.98）]、HIV 感染[HR=3.40（1.90-5.63）]、自身免疫性疾病[HR=2.01（1.10-3.33）]、消化性溃疡病[HR=1.57（1.05-2.26）]、肾脏疾病[HR=1.60（1.21-2.09）]和甲状腺疾病[HR=1.32（1.06-1.64）]均与 FN 风险显著增加相关。
这些结果提供了证据表明，几种慢性合并症的病史会增加 FN 的风险，在化疗期间管理患者时应考虑这一点。
