Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Wuhan, 430030, China.
Curr Med Sci. 2022 Jun;42(3):530-537. doi: 10.1007/s11596-022-2587-3. Epub 2022 Jun 1.
The influential factors of chemotherapy-induced myelosuppression in esophageal cancer in central China are unclear. This study aimed to investigate the effect of commonly used chemotherapy regimens on the incidence of myelosuppression in clinical treatment of esophageal cancer.
In this retrospective study, 624 patients with esophageal cancer who received six different chemotherapy regimens between 2013 and 2020 at our institute were included. Chemotherapy consisted of lobaplatin, 5-fluorouracil (5-F), lobaplatin and 5-F, nedaplatin, nedaplatin and paclitaxel (PTX), cisplatin and PTX. Multivariable logistic regression analysis was used to explore the risk of myelosuppression among the six different chemotherapy regimens.
Compared with lobaplatin group, the incidence of myelosuppression in patients treated with chemotherapy regimens of lobaplatin and 5-F, nedaplatin, nedaplatin and PTX and cisplatin and PTX were significantly ameliorated. The dose of lobaplatin was significantly reduced (P=0.007) when lobaplatin was combined with 5-F, and the combination could significantly reduce the risk of myelosuppression (P=0.022). Furthermore, chemotherapeutic regimens, the dose of platinum, hemoglobin and uric acid levels, age, sex, total bilirubin and immune-enhancing drugs were found to be strong predictors of developing myelosuppression.
Targeted preventive interventions that enhance immune function, reduce uric acid levels and choose combined medication during chemotherapy should be implemented for high-risk patients to reduce the occurrence of myelosuppression. In addition, the dose of lobaplatin should be adjusted when combined with other chemotherapy drugs to reduce the incidence of myelosuppression.
中国中部地区食管癌化疗引起的骨髓抑制的影响因素尚不清楚。本研究旨在探讨常用化疗方案对临床食管癌治疗中骨髓抑制发生率的影响。
本回顾性研究纳入了 2013 年至 2020 年期间在我院接受六种不同化疗方案治疗的 624 例食管癌患者。化疗方案包括洛铂、氟尿嘧啶（5-FU）、洛铂联合 5-FU、奈达铂、奈达铂联合紫杉醇（PTX）、顺铂联合 PTX。采用多变量逻辑回归分析探讨六种不同化疗方案中骨髓抑制的风险。
与洛铂组相比，接受洛铂联合 5-FU、奈达铂、奈达铂联合 PTX 和顺铂联合 PTX 化疗方案治疗的患者骨髓抑制发生率明显改善。当洛铂与 5-FU 联合使用时，洛铂的剂量显著降低（P=0.007），且联合用药可显著降低骨髓抑制的风险（P=0.022）。此外，化疗方案、铂类药物剂量、血红蛋白和尿酸水平、年龄、性别、总胆红素和免疫增强药物被发现是发生骨髓抑制的强预测因素。
对于高危患者，应实施增强免疫功能、降低尿酸水平和选择联合用药等针对性预防干预措施，以减少骨髓抑制的发生。此外，当与其他化疗药物联合使用时，应调整洛铂的剂量，以降低骨髓抑制的发生率。
