Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-Institut Català Oncologia, Bellvitge Institute for Biomedical Research, L'Hospitalet de Llobregat, Barcelona, Spain.
Neurological Department, Agios Andreas General Hospital of Patras, Patras, Greece.
Eur J Neurol. 2024 Dec;31(12):e16457. doi: 10.1111/ene.16457. Epub 2024 Sep 16.
Chemotherapy-induced peripheral neuropathy (CIPN) is perceived differently by patients and physicians, complicating its assessment. Current recommendations advocate combining clinical and patient-reported outcomes measures, but this approach can be challenging in patient care. This multicenter European study aims to bridge the gap between patients' perceptions and neurological impairments by aligning both perspectives to improve treatment decision-making.
Data were pooled from two prospective studies of subjects (n = 372) with established CIPN. Patient and physician views regarding CIPN were assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), Total Neuropathy Scale-clinical version (TNSc) items, and the disease-specific quality of life - Chemotherapy-Induced Peripheral Neuropathy questionnaire (QLQ-CIPN20) from the European Organization for Research and Treatment of Cancer (EORTC). To identify inherent neurotoxic severity patterns, we employed hierarchical cluster analysis optimized with k-means clustering and internally validated by discriminant functional analysis.
Both NCI-CTCAE and TNSc demonstrated a significant difference in the distribution of severity grades in relation to QLQ-CIPN20 scores. However, a proportion of subjects with different neurotoxic severity grades exhibited overlapping QLQ-CIPN20 scores. We identified three distinct clusters classifying subjects as having severely impaired, intermediately impaired, and mildly impaired CIPN based on TNSc and QLQ-CIPN20 scores. No differences in demographics, cancer type distribution, or class of drug received were observed.
Our results confirm the heterogeneity in CIPN perception between patients and physicians and identify three well-differentiated subgroups of patients delineated by degree of CIPN impairment based on scores derived from TNSc and QLQ-CIPN20. A more refined assessment of CIPN could potentially be achieved using the calculator tool derived from the cluster equations in this study. This tool, which facilitates individual patient classification, requires prospective validation.
化疗引起的周围神经病（CIPN）在患者和医生之间的感知不同，这使得其评估变得复杂。目前的建议主张将临床和患者报告的结果测量相结合，但这种方法在患者护理中可能具有挑战性。这项多中心欧洲研究旨在通过对齐两者的观点来缩小患者感知和神经损伤之间的差距，从而改善治疗决策。
汇总了两项已建立 CIPN 的受试者前瞻性研究的数据（n=372）。使用国家癌症研究所不良事件通用术语标准（NCI-CTCAE）、总神经病变量表临床版（TNSc）项目以及欧洲癌症研究与治疗组织（EORTC）的特定疾病质量生活量表-化疗诱导的周围神经病问卷（QLQ-CIPN20）评估患者和医生对 CIPN 的看法。为了确定内在神经毒性严重程度模式，我们使用了层次聚类分析，该分析使用了 K 均值聚类进行优化，并通过判别功能分析进行了内部验证。
NCI-CTCAE 和 TNSc 均显示在严重程度等级分布方面与 QLQ-CIPN20 评分有显著差异。然而，具有不同神经毒性严重程度等级的一部分患者具有重叠的 QLQ-CIPN20 评分。根据 TNSc 和 QLQ-CIPN20 评分，我们确定了三个不同的聚类，将患者分为严重受损、中度受损和轻度受损的 CIPN。在人口统计学、癌症类型分布或接受的药物类别方面没有观察到差异。
我们的结果证实了患者和医生之间对 CIPN 感知的异质性，并根据 TNSc 和 QLQ-CIPN20 评分确定了基于 CIPN 损伤程度的三个截然不同的患者亚组。使用该研究中聚类方程衍生的计算器工具可以更精细地评估 CIPN。该工具有助于对个体患者进行分类，需要进行前瞻性验证。
