Aagaard Theis, Roen Ashley, Reekie Joanne, Daugaard Gedske, Brown Peter de Nully, Specht Lena, Sengeløv Henrik, Mocroft Amanda, Lundgren Jens, Helleberg Marie
Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK.
JNCI Cancer Spectr. 2018 Nov 29;2(4):pky053. doi: 10.1093/jncics/pky053. eCollection 2018 Oct.
Febrile neutropenia (FN) after chemotherapy causes a high burden of morbidity and mortality. We aimed to develop and validate a risk score to predict FN in the first cycle of chemotherapy.
We included patients with solid cancers and diffuse large B-cell lymphomas at Rigshospitalet, University of Copenhagen, 2010-2016. Predictors of FN were analyzed using Poisson regression and random split-sampling.
Among 6294 patients in the derivation cohort, 360 developed FN. Female sex, older age, cancer type, disease stage, low albumin, elevated bilirubin, low creatinine clearance, infection before chemotherapy, and number of and type of chemotherapy drugs predicted FN. Compared with those at low risk (n = 2520, 40.0%), the incidence rate ratio of developing FN was 4.8 (95% confidence interval [CI] = 2.9 to 8.1), 8.7 (95% CI = 5.3 to 14.1) and 24.0 (95% CI = 15.2 to 38.0) in the intermediate (n = 1294, 20.6%), high (n = 1249, 19.8%) and very high (n = 1231, 19.6%) risk groups, respectively, corresponding to a number needed to treat with granulocyte colony-stimulating factors to avoid one FN event in the first cycle of 284, 60, 34 and 14. The discriminatory ability (Harrell's C-statistic = 0.80, 95% CI = 0.78 to 0.82) was similar in the validation cohort (n=3163) (0.79, 95% CI = 0.75 to 0.82).
We developed and internally validated a risk score for FN in the first cycle of chemotherapy. The FENCE score is available online and provides good differentiation of risk groups.
化疗后发热性中性粒细胞减少症（FN）会导致较高的发病和死亡负担。我们旨在开发并验证一种风险评分，以预测化疗第一周期中的FN。
我们纳入了2010年至2016年在哥本哈根大学 Rigshospitalet医院患有实体癌和弥漫性大B细胞淋巴瘤的患者。使用泊松回归和随机分割抽样分析FN的预测因素。
在推导队列的6294例患者中，360例发生了FN。女性、年龄较大、癌症类型、疾病分期、低白蛋白、胆红素升高、肌酐清除率低、化疗前感染以及化疗药物的数量和类型可预测FN。与低风险组（n = 2520，40.0%）相比，中风险组（n = 1294，20.6%）、高风险组（n = 1249，19.8%）和极高风险组（n = 1231，19.6%）发生FN的发病率比分别为4.8（95%置信区间[CI] = 2.9至8.1）、8.7（95%CI = 5.3至14.1）和24.0（95%CI = 15.2至38.0），这分别对应于在化疗第一周期中为避免1例FN事件所需使用粒细胞集落刺激因子治疗的人数为284、60、34和14。验证队列（n = 3163）中的鉴别能力（Harrell氏C统计量 = 0.80，95%CI = 0.78至0.82）与之相似（0.79，95%CI = 0.75至0.82）。
我们开发并在内部验证了化疗第一周期中FN的风险评分。FENCE评分可在线获取，并且能很好地区分风险组。
