Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan.
Department of Biostatistics, Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan.
JNCI Cancer Spectr. 2022 May 2;6(3). doi: 10.1093/jncics/pkac038.
The FEbrile Neutropenia after ChEmotherapy (FENCE) score was developed to estimate the risk of febrile neutropenia (FN) at first cycle of chemotherapy but has not been externally validated. We aimed to validate the FENCE score based on its risk groups in patients treated at a comprehensive cancer center.
We conducted a retrospective study of treatment-naïve adult patients with solid tumors and diffuse large B-cell lymphoma who received first-cycle chemotherapy between January and November 2019. Patients were followed until the second cycle of chemotherapy to identify any FN events (neutrophil count <0.5 × 109/L with fever ≥38.2°C). The FENCE score was determined and patients classified as low, intermediate, high, and very high risk. The discriminatory ability of classifying patients into FENCE risk groups was calculated as the area under the receiver operating characteristics curve and incidence rate ratios within each FENCE risk group.
FN was documented during the first cycle of chemotherapy in 45 of the 918 patients included (5%). The area under the receiver operating characteristics curve was 0.66 (95% confidence interval [CI] = 0.58 to 0.73). Compared with the low-risk group (n = 285), the incidence rate ratio of developing FN was 1.58 (95% CI = 0.54 to 5.21), 3.16 (95% CI = 1.09 to 10.25), and 3.93 (95% CI = 1.46 to 12.27) in the intermediate (n = 293), high (n = 162), and very high (n = 178) risk groups, respectively.
In this study, classifying patients into FENCE risk groups demonstrated moderate discriminatory ability for predicting FN. Further validation in multicenter studies is necessary to determine its generalizability.
FEbrile Neutropenia after ChEmotherapy（FENCE）评分用于评估首次化疗周期中性粒细胞减少性发热（FN）的风险，但尚未经过外部验证。我们旨在根据该评分的风险组在综合癌症中心接受治疗的患者中验证其有效性。
我们对 2019 年 1 月至 11 月期间接受首次化疗的初治成人实体瘤和弥漫性大 B 细胞淋巴瘤患者进行了回顾性研究。患者随访至第二周期化疗，以确定任何 FN 事件（中性粒细胞计数 <0.5×109/L 伴发热≥38.2°C）。确定 FENCE 评分，并将患者分为低危、中危、高危和极高危。通过计算接受者操作特征曲线下面积和每个 FENCE 风险组内的发病率比值来评估将患者分类为 FENCE 风险组的区分能力。
在纳入的 918 例患者中，有 45 例（5%）在首次化疗周期中出现 FN。接受者操作特征曲线下面积为 0.66（95%置信区间 [CI] = 0.58 至 0.73）。与低危组（n=285）相比，中危组（n=293）FN 发生率的风险比为 1.58（95%CI = 0.54 至 5.21），高危组（n=162）为 3.16（95%CI = 1.09 至 10.25），极高危组（n=178）为 3.93（95%CI = 1.46 至 12.27）。
在这项研究中，将患者分为 FENCE 风险组对预测 FN 具有中等的区分能力。需要在多中心研究中进一步验证其普遍性。
