Zecha Judith A E M, Raber-Durlacher Judith E, Laheij Alexa M G A, Westermann Anneke M, de Lange Jan, Smeele Ludi E
Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands.
Front Oral Health. 2022 Jun 30;3:940044. doi: 10.3389/froh.2022.940044. eCollection 2022.
Febrile neutropenia (FN) is a potential life-threatening complication of myelosuppressive chemotherapy, particularly when induced by infection. There is evidence that FN can originate from the oral cavity, but its contribution to FN is largely understudied in patients treated for solid tumors. The aim of this study was to assess the prevalence of FN in these patients and to evaluate its relation with dental foci and oral mucositis.
A prospective longitudinal observational study was conducted. Patients diagnosed with solid tumors and lymphoma scheduled to be treated with myelosuppressive chemotherapy with an intermediate risk of developing FN were included. A pre-chemotherapy dental examination was performed and patients were followed during and after chemotherapy regimen. During subsequent hospital visits for chemotherapy administration, the oral cavity was inspected and oral mucositis (OM) was scored using the CTC-AE version 3.0. When patients presented with fever, a comprehensive full body examination including laboratory/microbiological/imaging investigation was performed.
Eighty-eight patients were included. Pre-chemotherapy, 39 patients (44.3%) were diagnosed with a dental focus. During chemotherapy, 46 patients developed OM (53.4%), of which 15 patients had a maximum score of grade II (ulcerative mucositis). Ten patients developed FN during the follow-up period. Patients with FN more often suffered from ulcerative OM compared to patients without FN; both FN and mucositis risk was associated with the myelotoxicity of chemotherapy. However, no relation could be established between the presence of dental foci prior to chemotherapy and the development of FN ( > 0.05).
A significant relation was identified between ulcerative OM and FN, but no robust conclusions could be drawn with respect to a relationship between the presence of dental foci and FN.
发热性中性粒细胞减少症（FN）是骨髓抑制性化疗的一种潜在危及生命的并发症，尤其是由感染引起时。有证据表明FN可能起源于口腔，但在实体瘤治疗患者中，其对FN的影响在很大程度上未得到充分研究。本研究的目的是评估这些患者中FN的患病率，并评估其与牙源性病灶和口腔黏膜炎的关系。
进行了一项前瞻性纵向观察研究。纳入计划接受具有发生FN中度风险的骨髓抑制性化疗的实体瘤和淋巴瘤患者。化疗前进行牙科检查，并在化疗期间及化疗后对患者进行随访。在随后的化疗给药住院期间，检查口腔并使用3.0版CTC-AE对口腔黏膜炎（OM）进行评分。当患者出现发热时，进行包括实验室/微生物学/影像学检查在内的全面全身检查。
纳入88例患者。化疗前，39例患者（44.3%）被诊断有牙源性病灶。化疗期间，46例患者发生OM（53.4%），其中15例患者最高评分为II级（溃疡性黏膜炎）。10例患者在随访期间发生FN。与未发生FN的患者相比，发生FN的患者更常患有溃疡性OM；FN和黏膜炎风险均与化疗的骨髓毒性相关。然而，化疗前牙源性病灶的存在与FN的发生之间未发现相关性（P>0.05）。
确定了溃疡性OM与FN之间存在显著相关性，但关于牙源性病灶的存在与FN之间的关系，未能得出确凿结论。
