Deek Matthew P, Kim Sinae, Ahmed Inaya, Fang Bruno S, Zou Wei, Malhotra Jyoti, Aisner Joseph, Jabbour Salma K
Department of Radiation Oncology.
Department of Biostatistics, School of Public Health, Rutgers University, Piscataway.
Am J Clin Oncol. 2018 Apr;41(4):362-366. doi: 10.1097/COC.0000000000000293.
The aim of this study is to investigate the impact of missed chemotherapy administrations (MCA) on the prognosis of non-small cell lung cancer (NSCLC) patients treated with definitive chemoradiation therapy (CRT).
In total, 97 patients with NSCLC treated with definitive CRT were assessed for MCA due to toxicities. Logistic regression was used to determine factors associated with MCA. Kaplan-Meier curves, log-rank tests, and Cox Proportional Hazards models were conducted.
MCA occurred in 39% (n=38) of the patients. Median overall survival was 9.6 months for patients with MCA compared with 24.3 months for those receiving all doses (P=0.004). MCA due to decline in performance status was associated with the worst survival (4.6 mo) followed by allergic reaction (10.0 mo), hematologic toxicity (11 mo), and esophagitis (17.2 mo, P=0.027). In multivariate models, MCA was associated with higher mortality (hazard ratio, 1.97; P=0.01) and worse progression-free survival (hazard ratio, 1.96; P=0. 009).
MCA correlated with worse prognosis and increased mortality. Methods to reduce toxicity may improve administration of all chemotherapy doses and increase overall survival in NSCLC treated with CRT.
本研究旨在探讨错过化疗给药（MCA）对接受根治性放化疗（CRT）的非小细胞肺癌（NSCLC）患者预后的影响。
总共评估了97例接受根治性CRT治疗的NSCLC患者因毒性导致的MCA情况。采用逻辑回归分析确定与MCA相关的因素。进行了Kaplan-Meier曲线分析、对数秩检验和Cox比例风险模型分析。
39%（n = 38）的患者出现了MCA。MCA患者的中位总生存期为9.6个月，而接受全部剂量化疗的患者为24.3个月（P = 0.004）。因体能状态下降导致的MCA患者生存期最差（4.6个月），其次是过敏反应（10.0个月）、血液学毒性（11个月）和食管炎（17.2个月，P = 0.027）。在多变量模型中，MCA与较高的死亡率相关（风险比，1.97；P = 0.01），且无进展生存期较差（风险比，1.96；P = 0.009）。
MCA与较差的预后和死亡率增加相关。降低毒性的方法可能会改善所有化疗剂量的给药情况，并提高接受CRT治疗的NSCLC患者的总生存期。
