乳腺癌患者在密集化疗下需要输血的贫血症：患病率、风险因素、成本以及对疾病结果的影响。

Anemia requiring transfusion in breast cancer patients on dose-dense chemotherapy: Prevalence, risk factors, cost and effect on disease outcome.

机构信息

Department of Medical Oncology, Christian Medical College and Hospital, Tamil Nadu, Vellore, 632004, India.

Department of Biostatistics, Christian Medical College and Hospital, Tamil Nadu, 632004, Vellore, India.

出版信息

Support Care Cancer. 2022 Jun;30(6):5519-5526. doi: 10.1007/s00520-022-06970-2. Epub 2022 Mar 21.

DOI:10.1007/s00520-022-06970-2

PMID:35314996

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8937495/

Abstract

PURPOSE

Dose-dense chemotherapy improves survival but with increased toxicity and treatment-related cost. We report the prevalence of anemia and the possible risk factors associated with chemotherapy-related anemia and determine the cost and time-delay associated with transfusion requirement in Indian patients with non-metastatic breast cancer on dose-dense preoperative chemotherapy.

METHODS

In this study, triple-negative breast cancer (TNBC) patients were treated preoperatively with docetaxel and cyclophosphamide alternating with epirubicin and cisplatin every 2 weeks. Patients were evaluated for anemia pre- and post-chemotherapy. We examined trends in the red cell indices, transfusion requirement, time to transfusion, as well as risk factors associated with transfusion during treatment, along with delay in treatment due to anemia and the additional cost incurred.

RESULTS

A total of 116 consecutive women with nonmetastatic TNBC were treated with preoperative chemotherapy. The median age was 44.5 years. 56.1% of patients had stage III disease. Anemia was detected at baseline in 54 (46.5%) patients with mild anemia (10-12 g/dl) in 42 (36.2%) patients and moderate anemia (8-10 g/dl) in 12 (10.3%) patients. During the course of treatment, all patients developed anemia. A total of 44 patients (37.9%) required transfusion during chemotherapy, with 55(47.4%) patients developing grade 1-2 anemia and 40 (34.5%) patients developing grade 3 anemia. The factors associated with anemia requiring transfusion were a steeper decline in hemoglobin after two cycles (OR 1.65, p = 0.02), low-grade tumor (OR 2.48, p = 0.03), and thrombocytopenia grade 3 or 4 (OR 4.35, p = 0.034), of which tumor grade and thrombocytopenia remained significant in multivariate analysis. Nearly one-fourth of the study population had a delay between two cycles of chemotherapy due to anemia. A median additional cost of INR 7000 was incurred among those requiring blood transfusion.

CONCLUSION

Anemia is a common toxicity associated with dose-dense chemotherapy during curative breast cancer treatment leading to delay in treatment and increased cost. Low-grade tumor, grade 3 or 4 thrombocytopenia, and grade 2 or higher anemia after two cycles of chemotherapy are risk factors for blood transfusions during treatment.

摘要

目的

密集化疗可提高生存率，但会增加毒性和治疗相关费用。我们报告了贫血的发生率，并确定了非转移性乳腺癌患者接受密集术前化疗时与化疗相关贫血相关的可能危险因素，并确定了与输血相关的成本和时间延迟。

方法

在这项研究中，三阴性乳腺癌（TNBC）患者接受多西他赛和环磷酰胺每 2 周交替与表柔比星和顺铂的术前化疗。患者在化疗前后评估贫血情况。我们检查了红细胞指数的趋势、输血需求、输血时间以及治疗期间与输血相关的危险因素，以及因贫血而导致的治疗延迟和额外的费用。

结果

共对 116 例非转移性 TNBC 连续女性患者进行了术前化疗。中位年龄为 44.5 岁。56.1%的患者为 III 期疾病。54 例（46.5%）患者基线时存在贫血，其中 42 例（36.2%）为轻度贫血（10-12g/dl），12 例（10.3%）为中度贫血（8-10g/dl）。在治疗过程中，所有患者均出现贫血。共有 44 例（37.9%）患者在化疗期间需要输血，其中 55 例（47.4%）患者发生 1-2 级贫血，40 例（34.5%）患者发生 3 级贫血。与需要输血的贫血相关的因素是两个周期后血红蛋白下降更明显（OR 1.65，p=0.02）、低级别肿瘤（OR 2.48，p=0.03）和血小板减少症 3 级或 4 级（OR 4.35，p=0.034），其中肿瘤分级和血小板减少症在多变量分析中仍然具有显著性。由于贫血，近四分之一的研究人群在两个化疗周期之间出现了延迟。需要输血的患者平均额外花费 INR7000。