Timmins Hannah C, Li Tiffany, Goldstein David, Trinh Terry, Mizrahi David, Harrison Michelle, Horvath Lisa G, Friedlander Michael, Kiernan Matthew C, Park Susanna B
Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2050, Australia.
Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
J Cancer Surviv. 2022 Apr;16(2):223-232. doi: 10.1007/s11764-021-01012-y. Epub 2021 Feb 27.
Chemotherapy-induced peripheral neuropathy (CIPN) is a major side effect of neurotoxic cancer treatment, often impacting treatment tolerability and patient functioning. Factors predicting an individual's vulnerability for developing CIPN remain ill-defined. However, patient characteristics may contribute to CIPN risk, with obesity being a prevalent patient comorbidity. This study was aimed at evaluate if being overweight (BMI ≥ 25 kg/m) was associated with worse symptomatic, clinical, and functional CIPN following neurotoxic cancer treatment.
Three hundred seventy-nine cancer survivors were assessed 5 (IQR 3-5) months post oxaliplatin or paclitaxel treatment via comprehensive patient-reported, clinical, and functional CIPN measures. Patients classified as overweight (BMI ≥ 25 kg/m) were compared to those within the normal BMI range (< 25 kg/m). Multilinear regression was conducted to evaluate the association between patient clinical factors and CIPN severity.
Most patients reported CIPN symptoms (78%), with deficits evident on clinical examination. Overweight patients (n = 242, 63.8%) had significantly worse CIPN across symptomatic, objective clinical, and functional outcomes compared to those with a normal BMI (p < .05). In multivariate linear regression, older age (B = .088, 95%CI = .053-.122, p < .001), larger waist circumference (B = .030, 95%CI = .001-.059, p < .05), and larger BSA (B = 2.41, 95%CI = .34-04.48, p < .05) were associated with CIPN. Diabetes and BMI were significant on univariate analysis but not in the final models.
Overweight patients represent a large proportion of cancer survivors who may be particularly impacted by CIPN, requiring closer monitoring and referral to supportive services. Accessible data such as a patient's general and abdominal obesity status may aid in formulating personalized treatment.
Identifying routinely measured patient characteristics which may contribute to an individual's CIPN risk profile could assist with informing treatment decisions.
化疗引起的周围神经病变（CIPN）是神经毒性癌症治疗的主要副作用，常影响治疗耐受性和患者功能。预测个体发生CIPN易感性的因素仍不明确。然而，患者特征可能导致CIPN风险，肥胖是患者中普遍存在的合并症。本研究旨在评估超重（体重指数≥25kg/m²）是否与神经毒性癌症治疗后更严重的症状性、临床性和功能性CIPN相关。
379名癌症幸存者在接受奥沙利铂或紫杉醇治疗后5（四分位间距3 - 5）个月，通过患者全面报告、临床和功能性CIPN测量进行评估。将分类为超重（体重指数≥25kg/m²）的患者与体重指数在正常范围（<25kg/m²）内的患者进行比较。进行多线性回归以评估患者临床因素与CIPN严重程度之间的关联。
大多数患者报告有CIPN症状（78%），临床检查显示有明显缺陷。与体重指数正常的患者相比，超重患者（n = 242，63.8%）在症状性、客观临床和功能性结局方面的CIPN明显更严重（p <.05）。在多变量线性回归中，年龄较大（B =.088，95%置信区间 =.053 -.122，p <.001）、腰围较大（B =.030，95%置信区间 =.001 -.059，p <.05）和体表面积较大（B = 2.41, 95%置信区间 =.34 - 4.48，p <.05）与CIPN相关。糖尿病和体重指数在单变量分析中有显著意义，但在最终模型中无显著意义。
超重患者占癌症幸存者的很大比例，他们可能特别容易受到CIPN影响，需要更密切的监测并转介至支持性服务机构。诸如患者总体和腹部肥胖状况等可获取的数据可能有助于制定个性化治疗方案。
识别常规测量的可能导致个体CIPN风险特征的患者特征，有助于为治疗决策提供信息。
