分析头颈部癌症患者大剂量顺铂诱导肾损伤的危险因素。
Analysis of Risk Factors for High-dose Cisplatin-induced Renal Impairment in Head and Neck Cancer Patients.
机构信息
Department of Pharmacy, Shiga University of Medical Science Hospital, Shiga, Japan.
Department of Pharmacy, Shiga University of Medical Science Hospital, Shiga, Japan;
出版信息
In Vivo. 2022 Sep-Oct;36(5):2465-2472. doi: 10.21873/invivo.12982.
BACKGROUND/AIM: Concurrent chemoradiotherapy with high-dose cisplatin (CDDP-RT) is the standard therapy for advanced head and neck cancer; however, due to CDDP-induced renal impairment, dose reduction or discontinuation is frequently required. Therefore, the identification of risk factors for renal impairment is of importance to improve the efficacy and safety of CDDP-RT.
PATIENTS AND METHODS
We retrospectively investigated risk factors for renal impairment in advanced head and neck cancer patients receiving CDDP-RT. Renal impairment was defined as a >25% decrease from baseline in estimated glomerular filtration rate within 14 days after CDDP administration in the first cycle.
RESULTS
Of the 82 patients analyzed in this study, 21 (26%) patients developed renal impairment. Multivariate logistic regression analysis showed that concomitant use of a calcium channel blocker or lower hemoglobin levels significantly contributed to the increased risk of CDDP-induced renal impairment (odds ratio=3.60, 95% confidence interval=1.04-12.40; odds ratio=0.71, 95% confidence interval=0.50-0.99, respectively), while concomitant use of proton pump inhibitors was a factor associated with a decreased risk of CDDP-induced renal impairment (odds ratio=0.20, 95% confidence interval=0.04-0.86).
CONCLUSION
Renal function of patients receiving calcium channel blocker or patients with lower hemoglobin levels should be monitored cautiously when receiving CDDP-RT.
背景/目的：顺铂（CDDP）高剂量同期放化疗是治疗晚期头颈部癌症的标准疗法；然而，由于 CDDP 引起的肾损伤，经常需要减少剂量或停止治疗。因此，确定肾损伤的风险因素对于提高 CDDP-RT 的疗效和安全性非常重要。
患者和方法
我们回顾性调查了接受 CDDP-RT 的晚期头颈部癌症患者肾损伤的风险因素。肾损伤定义为在第一周期 CDDP 给药后 14 天内，估算肾小球滤过率从基线水平下降>25%。
结果
在本研究分析的 82 例患者中，21 例（26%）患者发生了肾损伤。多变量逻辑回归分析表明，同时使用钙通道阻滞剂或较低的血红蛋白水平显著增加了 CDDP 引起的肾损伤的风险（比值比=3.60，95%置信区间=1.04-12.40；比值比=0.71，95%置信区间=0.50-0.99），而质子泵抑制剂的同时使用是与 CDDP 引起的肾损伤风险降低相关的因素（比值比=0.20，95%置信区间=0.04-0.86）。
结论
在接受 CDDP-RT 治疗时，应密切监测使用钙通道阻滞剂的患者或血红蛋白水平较低的患者的肾功能。
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