Virginia Cancer Specialists, US Oncology Network, Arlington, VA.
Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA.
Clin Breast Cancer. 2018 Oct;18(5):380-386. doi: 10.1016/j.clbc.2018.02.003. Epub 2018 Feb 16.
The effects of chemotherapy dose intensity on patient outcomes in advanced cancer are not well understood. We studied the association between chemotherapy relative dose intensity (RDI) and overall survival (OS) among patients with advanced breast or ovarian cancer.
This retrospective cohort study included adults with advanced breast or ovarian cancer who received first-line myelosuppressive chemotherapy (January 2007 to December 2010) in US Oncology Network community practices. Dose delays ≥ 7 days, dose reductions ≥ 15%, and RDI relative to standard regimens were described. OS was measured by the Kaplan-Meier method and Cox proportional hazards models.
Among 874 patients with advanced breast cancer, 33.2% experienced dose delays ≥ 7 days, 48.7% experienced dose reductions ≥ 15%, and 38.9% had RDI < 85%. In the multivariable Cox proportional hazards model, Eastern Cooperative Oncology Group performance status 1/2 versus 0 (hazard ratio [HR] = 1.45; 95% confidence interval [CI], 1.15-1.82) and triple-negative status (HR = 3.14; 95% CI, 1.15-8.62) were significantly associated with mortality. Among 170 patients with advanced ovarian cancer, 43.5% experienced dose delays ≥ 7 days, 48.2% experienced dose reductions ≥ 15%, and 46.5% had RDI < 85%. In the multivariable Cox proportional hazards model, dose reductions ≥ 15% (HR = 1.94; 95% CI, 1.09-3.46) and other tumor histology (vs. nonserous adenocarcinoma; HR = 3.55; 95% CI, 1.38-9.09) were significantly associated with mortality.
Dose delays, dose reductions, and reduced RDI were common. In advanced breast cancer, health status and triple-negative disease were significantly associated with mortality. In advanced ovarian cancer, dose reductions and tumor histology were significantly associated with mortality. These results can help identify potential risk factors and characterize the effect of chemotherapy dose modification strategies on mortality.
化疗剂量强度对晚期癌症患者结局的影响尚不清楚。我们研究了晚期乳腺癌或卵巢癌患者中化疗相对剂量强度（RDI）与总生存期（OS）之间的关系。
这是一项回顾性队列研究，纳入了在美国肿瘤学网络社区实践中接受一线骨髓抑制性化疗（2007 年 1 月至 2010 年 12 月）的成人晚期乳腺癌或卵巢癌患者。描述了剂量延迟≥7 天、剂量减少≥15%和与标准方案相比的 RDI。通过 Kaplan-Meier 法和 Cox 比例风险模型测量 OS。
在 874 例晚期乳腺癌患者中，33.2%发生剂量延迟≥7 天，48.7%发生剂量减少≥15%，38.9%的 RDI＜85%。在多变量 Cox 比例风险模型中，东部肿瘤协作组体力状态 1/2 与 0（危险比[HR]1.45；95%置信区间[CI]1.15-1.82）和三阴性状态（HR 3.14；95%CI 1.15-8.62）与死亡率显著相关。在 170 例晚期卵巢癌患者中，43.5%发生剂量延迟≥7 天，48.2%发生剂量减少≥15%，46.5%的 RDI＜85%。在多变量 Cox 比例风险模型中，剂量减少≥15%（HR 1.94；95%CI 1.09-3.46）和其他肿瘤组织学（非浆液性腺癌；HR 3.55；95%CI 1.38-9.09）与死亡率显著相关。
剂量延迟、剂量减少和 RDI 降低较为常见。在晚期乳腺癌中，健康状况和三阴性疾病与死亡率显著相关。在晚期卵巢癌中，剂量减少和肿瘤组织学与死亡率显著相关。这些结果有助于识别潜在的危险因素，并描述化疗剂量调整策略对死亡率的影响。
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