Mohri Junichi, Katada Chikatoshi, Ueda Marie, Sugawara Mitsuhiro, Yamashita Keishi, Moriya Hiromitsu, Komori Shouko, Hayakawa Kazushige, Koizumi Wasaburo, Atsuda Koichiro
Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, Tokyo, Japan.
Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan.
J Transl Int Med. 2018 Mar 28;6(1):32-37. doi: 10.2478/jtim-2018-0007. eCollection 2018 Mar.
We retrospectively studied the predisposing factors for nephrotoxicity in the patients with advanced esophageal squamous-cell carcinoma who received combination chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF therapy).
Between January 2010 and March 2014, 41 patients with Stage IB to III esophageal squamous-cell carcinoma received the DCF therapy (docetaxel 70-75 mg/m, day 1; cisplatin 70-75 mg/m, day 1; 5-fluorouracil 750 mg/m, days 1-5) in our hospital. Renal dysfunction was defined as a creatinine clearance (Ccr) of less than 60 mL/min. Predictors of nephrotoxicity were identified through logistic-regression analysis.
Nephrotoxicity developed in 20 patients and did not develop in 21 patients. Nephrotoxicity developed during the first course of DCF therapy in 16 patients, the second course in 3 patients, and the third course in 1 patient. The dose of DCF therapy was decreased in 8 patients with nephrotoxicity and 7 patients without nephrotoxicity. Multivariate analysis showed that a low Ccr level immediately before DCF therapy was an independent risk factor for the development of nephrotoxicity (odds ratio, 0.932; 95% confidence interval, 0.876 to 0.992; = 0.027). On receiver operating characteristic curve analysis, the optimal cutoff value of Ccr for the development of nephrotoxicity was 75.8 mL/min. The 2-year overall survival rate was 84.2% in patients with nephrotoxicity and 90.0% in patients without nephrotoxicity ( = 0.635).
Low Ccr levels immediately before DCF therapy are a risk factor for the development of nephrotoxicity. Patients should therefore be carefully monitored.
我们回顾性研究了接受多西他赛、顺铂和5-氟尿嘧啶联合化疗（DCF疗法）的晚期食管鳞状细胞癌患者发生肾毒性的诱发因素。
2010年1月至2014年3月期间，41例IB期至III期食管鳞状细胞癌患者在我院接受了DCF疗法（多西他赛70 - 75mg/m²，第1天；顺铂70 - 75mg/m²，第1天；5-氟尿嘧啶750mg/m²，第1 - 5天）。肾功能不全定义为肌酐清除率（Ccr）低于60ml/min。通过逻辑回归分析确定肾毒性的预测因素。
20例患者发生肾毒性，21例患者未发生肾毒性。16例患者在DCF治疗的第一个疗程中发生肾毒性，3例在第二个疗程中发生，1例在第三个疗程中发生。8例发生肾毒性的患者和7例未发生肾毒性的患者减少了DCF疗法的剂量。多因素分析显示，DCF治疗前Ccr水平低是发生肾毒性的独立危险因素（比值比，0.932；95%置信区间，0.876至0.992；P = 0.027）。在受试者工作特征曲线分析中，发生肾毒性时Ccr的最佳临界值为75.8ml/min。发生肾毒性的患者2年总生存率为84.2%，未发生肾毒性的患者为90.0%（P = 0.635）。
DCF治疗前Ccr水平低是发生肾毒性的危险因素。因此，应对患者进行仔细监测。
