Dorand R Dixon, Zheng Neil S, Agarwal Rajiv, Carroll Robert J, Rubinstein Samuel M, Winkfield Karen M, Wei Wei-Qi, Berlin Jordan, Shu Xiao-Ou
Division of Hematology and Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA.
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, USA.
Cancers (Basel). 2023 Jan 26;15(3):754. doi: 10.3390/cancers15030754.
Chemotherapy-induced peripheral neuropathy (CIPN) is a common therapeutic complication affecting cancer patients' quality-of-life. We evaluated clinical characteristics, demographics, and lifestyle factors in association with CIPN following taxane treatment.
Data were extracted from the electronic health record of 3387 patients diagnosed with a primary cancer and receiving taxane (i.e., paclitaxel or docetaxel) at Vanderbilt University Medical Center. Neuropathy was assessed via a validated computer algorithm. Univariate and multivariate regression models were applied to evaluate odds ratios (ORs) and 95% confidence intervals (CIs) of CIPN-associated factors.
Female sex (OR = 1.28, 95% CI = 1.01-1.62), high body-mass index (BMI) (OR = 1.31, 95% CI = 1.06-1.61 for overweight, and OR = 1.49, 95% CI = 1.21-1.83 for obesity), diabetes (OR = 1.66, 95% CI = 1.34-2.06), high mean taxane dose (OR = 1.05, 95% CI = 1.03-1.08 per 10 mg/m), and more treatment cycles (1.12, 95% CI = 1.10-1.14) were positively associated with CIPN. Concurrent chemotherapy (OR = 0.74, 95% CI = 0.58-0.94) and concurrent radiotherapy (OR = 0.77, 95% CI = 0.59-1.00) were inversely associated with CIPN. Obesity and diabetes both had a stronger association with docetaxel CIPN compared to paclitaxel, although interaction was only significant for diabetes and taxane ( = 0.019). Increased BMI was associated with CIPN only among non-diabetic patients (OR:1.34 for overweight and 1.68 for obesity), while diabetes increased CIPN risk across all BMI strata (ORs were 2.65, 2.41, and 2.15 for normal weight, overweight, and obese, respectively) compared to normal-weight non-diabetic patients ( for interaction = 0.039).
Female sex, obesity, and diabetes are significantly associated with taxine-induced CIPN. Further research is needed to identify clinical and pharmacologic strategies to prevent and mitigate CIPN in at-risk patient populations.
化疗引起的周围神经病变（CIPN）是一种常见的治疗并发症，会影响癌症患者的生活质量。我们评估了紫杉烷治疗后与CIPN相关的临床特征、人口统计学和生活方式因素。
数据从范德比尔特大学医学中心3387例诊断为原发性癌症并接受紫杉烷（即紫杉醇或多西他赛）治疗的患者的电子健康记录中提取。通过经过验证的计算机算法评估神经病变。应用单变量和多变量回归模型来评估CIPN相关因素的比值比（OR）和95%置信区间（CI）。
女性（OR = 1.28，95%CI = 1.01 - 1.62）、高体重指数（BMI）（超重时OR = 1.31，95%CI = 1.06 - 1.61；肥胖时OR = 1.49，95%CI = 1.21 - 1.83）、糖尿病（OR = 1.66，95%CI = 1.34 - 2.06）、高平均紫杉烷剂量（每10mg/m²时OR = 1.05，95%CI = 1.03 - 1.08）以及更多的治疗周期（1.12，95%CI = 1.10 - 1.14）与CIPN呈正相关。同时进行化疗（OR = 0.74，95%CI = 0.58 - 0.94）和同时进行放疗（OR = 0.77，95%CI = 0.59 - 1.00）与CIPN呈负相关。与紫杉醇相比，肥胖和糖尿病与多西他赛引起的CIPN的关联更强，尽管仅糖尿病与紫杉烷之间的相互作用具有显著性（P = 0.019）。BMI增加仅在非糖尿病患者中与CIPN相关（超重时OR为1.34，肥胖时OR为1.68），而与正常体重的非糖尿病患者相比，糖尿病在所有BMI分层中均增加CIPN风险（正常体重、超重和肥胖时的OR分别为2.65、2.41和2.15）（相互作用P = 0.039）。
女性、肥胖和糖尿病与紫杉烷诱导的CIPN显著相关。需要进一步研究以确定在高危患者群体中预防和减轻CIPN的临床和药理学策略。
