Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
BMC Cancer. 2018 Oct 5;18(1):958. doi: 10.1186/s12885-018-4869-5.
Paclitaxel induced peripheral neuropathy (PIPN) is a major debilitating side effect of paclitaxel in patients with breast cancer with no fully known mechanisms. The aim of the study was to find out the possible risk factors for PIPN.
Eligible patients with node positive breast cancer undergoing chemotherapy with paclitaxel were assessed. They belonged to an initial randomized controlled trial in which the effectiveness of omega-3 fatty acids in preventing and reducing severity of PIPN was evaluated (protocol ID: NCT01049295). Reduced total neuropathy score (r-TNS) was used for measuring PIPN. All analyses were performed adjusting for intervention effect. The association between age, BMI, BSA, pathological grade, molecular biomarkers and PIPN was evaluated.
Fifty-seven patients with breast cancer were investigated. Age was significantly associated with risk of PIPN (RR:1.50, P value = .024). Body mass index and BSA had significant association with severity of PIPN (B:1.28, P = .025; and B: 3.88, P = .010 respectively). Also, BSA showed a significant association with the risk of PIPN (RR: 2.28, P = .035; B: 3.88, P = .035). Incidence and severity of PIPN were much more pronounced in progesterone receptor positive (PR) patients (RR:1.88, P = .015 and B:1.54, P = .012). Multivariate analysis showed that age and the status of PR were independent risk factor for incidence and the status of PR was the only independent risk factor for severity of PIPN.
Age, BSA and the status of PR, should be considered as the risk factors for PIPN before commencement of chemotherapy with paclitaxel in patients with breast cancer. Older patients, those with greater BSA and PR patients may need closer follow up and more medical attention due to greater incidence and severity of PIPN.
紫杉醇诱导的周围神经病变（PIPN）是乳腺癌患者紫杉醇治疗的主要致残性副作用，但其发病机制尚不完全清楚。本研究旨在探讨 PIPN 的可能危险因素。
对接受紫杉醇化疗的淋巴结阳性乳腺癌患者进行评估。他们属于一项初始随机对照试验的一部分，该试验评估了ω-3 脂肪酸在预防和减轻 PIPN 严重程度方面的有效性（方案 ID：NCT01049295）。采用简化的总神经病变评分（r-TNS）来评估 PIPN。所有分析均在调整干预效果的基础上进行。评估了年龄、BMI、BSA、病理分级、分子生物标志物与 PIPN 的关系。
共调查了 57 例乳腺癌患者。年龄与 PIPN 风险显著相关（RR：1.50，P 值=0.024）。BMI 和 BSA 与 PIPN 严重程度显著相关（B：1.28，P=0.025；B：3.88，P=0.010）。BSA 与 PIPN 风险也显著相关（RR：2.28，P=0.035；B：3.88，P=0.035）。孕激素受体阳性（PR）患者的 PIPN 发生率和严重程度明显更高（RR：1.88，P=0.015；B：1.54，P=0.012）。多变量分析显示，年龄和 PR 状态是 PIPN 发生的独立危险因素，而 PR 状态是 PIPN 严重程度的唯一独立危险因素。
在开始乳腺癌患者紫杉醇化疗之前，应考虑年龄、BSA 和 PR 状态作为 PIPN 的危险因素。年龄较大、BSA 较大和 PR 阳性的患者可能需要更密切的随访和更多的医疗关注，因为他们的 PIPN 发生率和严重程度更高。
