School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR.
Department of Clinical Oncology, Queen Elisabeth Hospital, Hong Kong, Hong Kong SAR.
Brain Behav. 2019 Jun;9(6):e01312. doi: 10.1002/brb3.1312. Epub 2019 May 7.
Chemotherapy-induced peripheral neuropathy (CIPN) is a significant and difficult to manage side effect of neurotoxic chemotherapies. Several risk factors for CIPN have been identified to date, but inconsistencies and methodological limitations exist in past research. Also, a limited number of potential risk factors has been investigated in the past.
The objective of this study was to assess the relative contribution of a wider range of risk factors in the development of CIPN.
This analysis used the 6-month data after starting chemotherapy from a larger prospective observational study on CIPN risk, prevalence, and quality of life. Patients were assessed at recruitment for possible CIPN risk factors, including prior history of neuropathies, current/past infectious diseases; neurotoxic medication history; personal and treatment characteristics; smoking history, alcohol use, and vegetable/fruit intake. Neuropathy was assessed at 6-months after starting chemotherapy with the neuropathy (motor/sensory) items of the NCI-CTCAE scale and the WHO criterion for neuropathy. Data on symptom burden were also collected.
Data were available from 255 patients from three cancer centers in Hong Kong, Singapore, and UK. The use of different scales did not always identify the same predictor variables. Key risk factors in multivariate regression models included older age (highest OR = 1.08, p < 0.01 with the WHO scale), chemotherapy (platinum-based chemotherapy had OR = 0.20-0.27 in developing CIPN compared to taxane-based chemotherapy), history of neuropathy (for motor CIPN only, OR = 8.36, p < 0.01), symptom burden (OR = 1.06, p < 0.05), number of chemotherapy cycles received (OR = 1.19-1.24, p < 0.01), and alcohol intake (OR = 0.32, p < 0.05). In univariate analysis, the use of statins was implicated with CIPN (p = 0.03-0.04 with different assessments) and diabetes showed a trend (p = 0.09) in the development of CIPN.
This study confirmed the CIPN risk related to certain variables and identified new ones. This knowledge can assist with treatment decisions and patient education.
化疗引起的周围神经病（CIPN）是一种严重且难以治疗的神经毒性化疗药物的副作用。迄今为止，已经确定了几种 CIPN 的危险因素，但过去的研究存在不一致和方法学上的局限性。此外，过去调查的潜在危险因素数量有限。
本研究旨在评估更广泛的危险因素在 CIPN 发展中的相对贡献。
本分析使用了一项关于 CIPN 风险、患病率和生活质量的前瞻性观察研究中开始化疗后 6 个月的数据。在招募时，患者接受了可能的 CIPN 危险因素评估，包括既往神经病史、当前/过去传染病、神经毒性药物史、个人和治疗特征、吸烟史、饮酒和蔬菜/水果摄入量。在开始化疗后 6 个月，使用 NCI-CTCAE 量表的神经病变（运动/感觉）项目和 WHO 神经病标准评估神经病变。还收集了症状负担数据。
来自香港、新加坡和英国的三个癌症中心的 255 名患者的数据可用。使用不同的量表并不总是确定相同的预测变量。多变量回归模型中的关键危险因素包括年龄较大（使用 WHO 量表时最高 OR=1.08，p<0.01）、化疗（与紫杉烷类化疗相比，基于铂类的化疗发生 CIPN 的 OR=0.20-0.27）、神经病史（仅运动性 CIPN，OR=8.36，p<0.01）、症状负担（OR=1.06，p<0.05）、接受的化疗周期数（OR=1.19-1.24，p<0.01）和饮酒（OR=0.32，p<0.05）。在单变量分析中，他汀类药物的使用与 CIPN 有关（不同评估时 p=0.03-0.04），糖尿病也显示出与 CIPN 相关的趋势（p=0.09）。
本研究证实了某些变量与 CIPN 相关的风险，并确定了新的风险因素。这些知识可以协助治疗决策和患者教育。
