Chen Y, Wang Y R, Shi Y, Dai G H
Medical Oncology of Department 2, Chinese PLA General Hospital, Beijing, 100853, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2017 Aug 18;49(4):669-674.
To evaluate the prognostic value of chemotherapy-induced neutropenia (CIN) in metastatic colon cancer undergoing first-line chemotherapy with FOLFOX.
Data were collected from a retrospective survey of 158 consecutive metastatic colon cancer patients who had undergone FOLFOX chemotherapy. The clinicopathological characteristics and chemotherapy features of the patients were analyzed as potential prognostic factors. The patients were stratified by the decreased level of CIN to three groups: large decreased level (the number of neutrophil decreased more than 1.0×10 compared with that before chemotherapy), small decreased level (the number of neutrophil decreased less than 1.0×10 compared with that before chemotherapy) and the absence of neutropenia.
According to a multivariate COX model, decreased level of CIN was a independent prognostic factor of colon cancer patients. Hazard ratios of death were 0.687 (95% CI: 0.381-0.812, P=0.016) for patients with large decreased level of CIN and 0.817 (95% CI: 0.527-0.939, P=0.027) for those with small decreased level of CIN compared with those of absent neutropenia patients. Median overall survival was 12.9 months (95% CI: 10.4-15.4) for patients without neutropenia (A) compared with 20.8 months (95% CI: 18.3-23.1) for patients with large-decreased level of CIN (L) and with 17.3 months (95% CI: 16.2-18.8) for those with small-decreased level of CIN (S vs. L, P=0.018; L vs. A, P=0.009; S vs. A, P=0.011).
Our results demonstrate that the decreased level of CIN is a predictor of prognosis in patients with metastatic colon cancer undergoing FOLFOX chemotherapy. Patients who have experienced large decreased level of CIN haave longer survival time than small decreased level of CIN or absent patients. To monitor CIN decreased level timely and adjust chemotherapy drug dose may help improve the prognosis.
评估化疗引起的中性粒细胞减少（CIN）对接受一线FOLFOX化疗的转移性结肠癌患者的预后价值。
收集158例连续接受FOLFOX化疗的转移性结肠癌患者的回顾性调查数据。分析患者的临床病理特征和化疗特征作为潜在的预后因素。根据CIN降低水平将患者分为三组：大幅降低组（中性粒细胞数量较化疗前减少超过1.0×10）、小幅降低组（中性粒细胞数量较化疗前减少少于1.0×10）和无中性粒细胞减少组。
根据多变量COX模型，CIN降低水平是结肠癌患者的独立预后因素。与无中性粒细胞减少的患者相比，CIN大幅降低组患者的死亡风险比为0.687（95%CI：0.381 - 0.812，P = 0.016），CIN小幅降低组患者的死亡风险比为0.817（95%CI：0.527 - 0.939，P = 0.027）。无中性粒细胞减少的患者（A组）中位总生存期为12.9个月（95%CI：10.4 - 15.4），CIN大幅降低组（L组）为20.8个月（95%CI：18.3 - 23.1），CIN小幅降低组（S组）为17.3个月（95%CI：16.2 - 18.8）（S组与L组比较，P = 0.018；L组与A组比较，P = 0.009；S组与A组比较，P = 0.011）。
我们的结果表明，CIN降低水平是接受FOLFOX化疗的转移性结肠癌患者预后的一个预测指标。CIN大幅降低的患者比CIN小幅降低或无降低的患者生存时间更长。及时监测CIN降低水平并调整化疗药物剂量可能有助于改善预后。
