Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
Support Care Cancer. 2023 Aug 3;31(8):505. doi: 10.1007/s00520-023-07978-y.
Although there have been reports of chemotherapy-induced nausea and vomiting (CINV) beyond 120 h, its overall prevalence has not been systematically examined. The aim of this review and meta-analysis was to report on the prevalence of this long-delayed CINV.
This review was registered on PROSPERO (CRD42022346963). PubMed (Medline), Embase, and Cochrane Central were searched from inception until August 2022. Articles were included if they reported on CINV > 120 h after initiation of the chemotherapy regimen and patients received a single-agent highly emetogenic (HEC) or moderately emetogenic (MEC) antineoplastic agent for 1 day alone or in combination with low/minimal emetogenic chemotherapy. For all eligible articles, individual study authors were contacted and requested to provide individual patient-level data of demographics, emetogenicity of chemotherapy regimens, and daily incidence of nausea and vomiting. Forward stepwise logistic regression identified predictors for the incident day's CINV based on prior day's CINV episodes, controlling for patient demographics, and stratified by regimen emetogenicity.
A total of 2048 patients from 2 studies were included in this individual patient data meta-analysis: 1333 patients (65%) received HEC and 715 (35%) received MEC. Among those receiving HEC, 325 (24%) experienced acute, 652 (49%) delayed, and 393 (31%) long-delayed nausea; 107 (8%) experienced acute, 179 (14%) delayed, and 79 (6%) long-delayed vomiting. Among those receiving MEC, 48 (7%) experienced acute, 272 (38%) delayed, and 167 (24%) long-delayed nausea; 12 (2%) experienced acute, 97 (14%) delayed, and 42 (6%) long-delayed vomiting. Nausea in the long-delayed phase was as severe as in the delayed phase. Patients experiencing nausea and vomiting on days 4 and 5 were at significant risk of experiencing long-delayed CINV.
While not as prevalent as delayed nausea and vomiting, long-delayed CINV affects a significant proportion of patients and severity is similar. Patients with delayed CINV, specifically on days 4-5, are at risk of experiencing long-delayed CINV.
尽管有报道称化疗引起的恶心和呕吐（CINV）超过 120 小时，但尚未系统地检查其总体发生率。本综述和荟萃分析的目的是报告这种长期延迟的 CINV 的发生率。
本综述已在 PROSPERO（CRD42022346963）上注册。从开始到 2022 年 8 月，检索了 PubMed（Medline）、Embase 和 Cochrane Central。如果文章报告了化疗方案开始后 120 小时以上出现 CINV，并且患者接受了单一高致吐性（HEC）或中度致吐性（MEC）抗肿瘤药物治疗 1 天，单独或与低/最小致吐性化疗联合使用，则纳入研究。对于所有符合条件的文章，都联系了个别研究作者，并要求他们提供关于患者人口统计学、化疗方案致吐性和每日恶心和呕吐发生率的个体患者水平数据。向前逐步逻辑回归根据前一天的 CINV 发作，识别出与方案致吐性分层的当天 CINV 发作的预测因子，同时控制患者人口统计学。
共有 2 项研究的 2048 名患者纳入本项个体患者数据荟萃分析：1333 名患者（65%）接受了 HEC，715 名患者（35%）接受了 MEC。在接受 HEC 的患者中，325 名（24%）出现急性、652 名（49%）延迟和 393 名（31%）长期延迟性恶心；107 名（8%）出现急性、179 名（14%）延迟和 79 名（6%）长期延迟性呕吐。在接受 MEC 的患者中，48 名（7%）出现急性、272 名（38%）延迟和 167 名（24%）长期延迟性恶心；12 名（2%）出现急性、97 名（14%）延迟和 42 名（6%）长期延迟性呕吐。在长期延迟阶段，恶心与延迟阶段一样严重。在第 4 天和第 5 天出现恶心和呕吐的患者发生长期延迟性 CINV 的风险显著增加。
虽然不如延迟性恶心和呕吐常见，但长期延迟性 CINV 仍会影响相当比例的患者，且严重程度相似。有延迟性 CINV 的患者，特别是在第 4-5 天，有发生长期延迟性 CINV 的风险。
