Kurihara Tatsuya, Kogo Mari, Ishii Masakazu, Shimada Ken, Yoneyama Keiichiro, Kitamura Katsuya, Shimizu Shunichi, Yoshida Hitoshi, Kiuchi Yuji
Division of Physiology and Pathology, Department of Pharmacology, Toxicology and Therapeutics, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
Department of Hospital Pharmaceutics, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
Cancer Chemother Pharmacol. 2015 Dec;76(6):1217-24. doi: 10.1007/s00280-015-2887-4. Epub 2015 Nov 11.
We conducted a retrospective cohort study to examine whether neutropenia could be an indicator of good prognosis in patients treated with gemcitabine (GEM) for unresectable pancreatic cancer.
A total of 178 patients with unresectable pancreatic cancer, who were treated with first-line (n = 121) or second-line (n = 57) GEM, were included in our analyses. A Cox proportional hazard model was used to examine the effect of the grade of GEM-induced neutropenia on prognosis. Furthermore, the difference in survival time for each grade was assessed using a log-rank test.
In the first-line population, the hazard ratios of patients with grade 2 or grade 3 neutropenia compared with the ratios of those without neutropenia (grade 0) were 0.43 (95% CI 0.27-0.70) and 0.37 (0.21-0.65), respectively (p < 0.05). The median survival time (MST) was 3.8 months for grade 0, 9.4 months for grade 2, and 10.1 for grade 3. Landmark analysis of the second-line population revealed a hazard ratio of 0.52 (0.30-0.82) for grade 1 and 0.49 for grade 2 (0.28-0.72) (p < 0.05). MST was 1.3 months for grade 0, 4.7 months for grade 1, and 4.6 months for grade 2.
We found that neutropenia grade was an indicator of good prognosis in patients treated with first-line and second-line GEM for unresectable pancreatic cancer. A prospective study should be performed to examine whether dosage adjustment using neutropenia grade as an indicator would improve prognosis.
我们开展了一项回顾性队列研究，以探讨中性粒细胞减少是否可作为吉西他滨（GEM）治疗不可切除胰腺癌患者预后良好的指标。
共有178例接受一线（n = 121）或二线（n = 57）GEM治疗的不可切除胰腺癌患者纳入我们的分析。采用Cox比例风险模型来检验GEM诱导的中性粒细胞减少分级对预后的影响。此外，使用对数秩检验评估各分级的生存时间差异。
在一线治疗人群中，2级或3级中性粒细胞减少患者的风险比与无中性粒细胞减少（0级）患者的风险比分别为0.43（95%CI 0.27 - 0.70）和0.37（0.21 - 0.65）（p < 0.05）。0级的中位生存时间（MST）为3.8个月，2级为9.4个月，3级为10.1个月。二线治疗人群的标志性分析显示，1级的风险比为0.52（0.30 - 0.82），2级为0.49（0.28 - 0.72）（p < 0.05）。0级的MST为1.3个月，1级为4.7个月，2级为4.6个月。
我们发现中性粒细胞减少分级是接受一线和二线GEM治疗的不可切除胰腺癌患者预后良好的指标。应进行前瞻性研究，以检验以中性粒细胞减少分级为指标进行剂量调整是否会改善预后。
