Department of Population Health Sciences, University of Central Florida College of Medicine, 6900 Lake Nona Blvd., Orlando, FL, 328270, USA.
Department of Statistics & Data Science, University of Central Florida College of Sciences, Orlando, FL, USA.
Support Care Cancer. 2023 Jun 9;31(7):386. doi: 10.1007/s00520-023-07850-z.
The purpose of this retrospective cohort study was to evaluate whether several potentially preventive therapies reduced the rate of oxaliplatin-induced peripheral neuropathy (OIPN) in colorectal cancer patients and to assess the relationship of sociodemographic/clinical factors with OIPN diagnosis.
Data were obtained from the Surveillance, Epidemiology, and End Results database combined with Medicare claims. Eligible patients were diagnosed with colorectal cancer between 2007 and 2015, ≥ 66 years of age, and treated with oxaliplatin. Two definitions were used to denote diagnosis of OIPN based on diagnosis codes: OIPN 1 (specific definition, drug-induced polyneuropathy) and OIPN 2 (broader definition, additional codes for peripheral neuropathy). Cox regression was used to obtain hazard ratios (HR) with 95% confidence intervals (CI) for the relative rate of OIPN within 2 years of oxaliplatin initiation.
There were 4792 subjects available for analysis. At 2 years, the unadjusted cumulative incidence of OIPN 1 was 13.1% and 27.1% for OIPN 2. For both outcomes, no therapies reduced the rate of OIPN diagnosis. The anticonvulsants gabapentin and oxcarbazepine/carbamazepine were associated with an increased rate of OIPN (both definitions) as were increasing cycles of oxaliplatin. Compared to younger patients, those 75-84 years of age experienced a 15% decreased rate of OIPN. For OIPN 2, prior peripheral neuropathy and moderate/severe liver disease were also associated with an increased hazard rate. For OIPN 1, state buy-in health insurance coverage was associated with a decreased hazard rate.
Additional studies are needed to identify preventive therapeutics for OIPN in cancer patients treated with oxaliplatin.
本回顾性队列研究旨在评估几种潜在的预防疗法是否能降低结直肠癌患者奥沙利铂诱导的周围神经病变（OIPN）的发生率，并评估社会人口统计学/临床因素与 OIPN 诊断的关系。
数据来自 Surveillance, Epidemiology, and End Results 数据库与 Medicare 索赔相结合。符合条件的患者在 2007 年至 2015 年间被诊断患有结直肠癌，年龄≥66 岁，并接受奥沙利铂治疗。根据诊断代码，使用两种定义来表示 OIPN 的诊断：OIPN1（特定定义，药物诱导的多发性神经病）和 OIPN2（更广泛的定义，周围神经病的其他代码）。使用 Cox 回归获得奥沙利铂治疗开始后 2 年内 OIPN 相对发生率的风险比（HR）和 95%置信区间（CI）。
共有 4792 名患者可用于分析。在 2 年内，未经调整的 OIPN1 的累积发生率为 13.1%，OIPN2 的累积发生率为 27.1%。对于这两种结果，没有任何治疗方法能降低 OIPN 的诊断率。抗惊厥药加巴喷丁和奥卡西平/卡马西平与 OIPN 发生率增加（两种定义）有关，奥沙利铂的周期增加也是如此。与年轻患者相比，75-84 岁的患者 OIPN 发生率降低了 15%。对于 OIPN2，先前的周围神经病变和中重度肝脏疾病也与更高的危险率相关。对于 OIPN1，州医保覆盖范围与降低的危险率相关。
需要进一步研究以确定奥沙利铂治疗的癌症患者 OIPN 的预防治疗方法。
