Department of Gynecology, Shandong Provincial Qianfoshan Hospital, Shandong Second Medical University, Key Laboratory of Laparoscopic Technology, the First Affiliated Hospital of Shandong First Medical University, Jinan, China.
School of Public Health, Shandong Second Medical University, Weifang, China.
Radiat Oncol. 2024 Jun 18;19(1):76. doi: 10.1186/s13014-024-02469-8.
This retrospective study aimed to investigate the factors influencing the occurrence of neutropenia in patients with endometrial cancer (EC) following adjuvant chemoradiotherapy (CRT).
Retrospective analysis of EC patients who underwent adjuvant CRT from January 2012 to June 2023 in the Department of Gynecology and Oncology of the First Affiliated Hospital of Shandong First Medical University. Neutropenia was defined as an Absolute Neutrophil Count (ANC) of peripheral blood neutrophils below 2 × 10/L. Factors affecting neutropenia in EC patients treated with CRT using Generalized Estimating Equation (GEE), and Logistic regression was used to further analyze the effect of adding radiotherapy to different chemotherapy cycles on neutropenia, so that patients receive optimal adjuvant CRT while the risk of neutropenia is appropriately controlled.
A total of 144 patients met the inclusion criteria. They underwent 330 cycles of adjuvant chemotherapy, of whom 96 (66.7%) developed neutropenia, which occurred 140 times. The results of one-way GEE analysis showed that before CRT, White Blood Cell (WBC) (OR = 0.827; 95%CI, 0.701-0.976), ANC (OR = 0.749; 95%CI, 0.586-0.957), Absolute Monocyte Count (AMC) (OR = 0.047; 95%CI, 0.008-0.283), Blood Urea Nitrogen (BUN) (OR = 0.857; 95%CI, 0.741-0.991), platinum and docetaxel (platinum/docetaxel) dosing regimen (OR = 2.284; 95%CI, 1.130-4.618) were associated with neutropenia with adjuvant CRT for EC (p < 0.05), results of multifactorial GEE analysis showed that before adjuvant CRT ANC (OR = 0.552; 95%CI, 0.973-2.231), AMC (OR = 0.047; 95%CI, 0.004-0.052), platinum/docetaxel (OR = 2.437; 95%CI, 1.087-5.464) were an independent influence on neutropenia in adjuvant CRT for EC (p < 0.05). Multifactorial Logistic regression shows addition of radiotherapy to the first cycle of chemotherapy (OR = 4.413; 95%CI, 1.238-18.891) was an independent influence of neutropenia (p < 0.05).
Patients with low pre-CRT ANC and AMC, platinum/docetaxel dosing regimens need to be closely monitored during each cycle of CRT. Also, the concurrent addition of radiotherapy should be avoided during the first cycle of chemotherapy.
本回顾性研究旨在探讨子宫内膜癌（EC）患者接受辅助放化疗（CRT）后中性粒细胞减少症发生的影响因素。
回顾性分析 2012 年 1 月至 2023 年 6 月在山东第一医科大学第一附属医院妇科和肿瘤科接受辅助 CRT 的 EC 患者。中性粒细胞减少症定义为外周血中性粒细胞绝对计数（ANC）低于 2×10/L。使用广义估计方程（GEE）分析 CRT 治疗 EC 患者中性粒细胞减少的影响因素，并进一步使用 Logistic 回归分析不同化疗周期添加放疗对中性粒细胞减少的影响，以便患者接受最佳的辅助 CRT，同时适当控制中性粒细胞减少症的风险。
共有 144 名患者符合纳入标准。他们接受了 330 个周期的辅助化疗，其中 96 名（66.7%）发生了中性粒细胞减少症，共发生了 140 次。单向 GEE 分析结果显示，在 CRT 前，白细胞（WBC）（OR=0.827；95%CI，0.701-0.976）、ANC（OR=0.749；95%CI，0.586-0.957）、绝对单核细胞计数（AMC）（OR=0.047；95%CI，0.008-0.283）、血尿素氮（BUN）（OR=0.857；95%CI，0.741-0.991）、铂类和多西他赛（铂类/多西他赛）给药方案（OR=2.284；95%CI，1.130-4.618）与 EC 患者接受辅助 CRT 的中性粒细胞减少症相关（p<0.05）。多因素 GEE 分析结果显示，在辅助 CRT 前 ANC（OR=0.552；95%CI，0.973-2.231）、AMC（OR=0.047；95%CI，0.004-0.052）、铂类/多西他赛（OR=2.437；95%CI，1.087-5.464）是影响 EC 患者辅助 CRT 中性粒细胞减少症的独立因素（p<0.05）。多因素 Logistic 回归显示，在第一周期化疗中添加放疗（OR=4.413；95%CI，1.238-18.891）是中性粒细胞减少症的独立影响因素（p<0.05）。
在 CRT 期间，需要密切监测每个周期前 ANC 和 AMC 较低的患者。同时，应避免在第一周期化疗中同时添加放疗。
