高体重指数预示着从口服阿片类药物转换为透皮芬太尼时癌症疼痛缓解不佳：一项双中心回顾性研究。

High BMI predicts poor cancer pain relief when rotating from oral opioids to transdermal Fentanyl: a two-center retrospective study.

作者信息

Chen Ya, Han Songling, Hu Xiaogang, Ma Xue, Qiu Yue, Tang Yuelu, Wang Xiaoxiao, Li Lixian, Li Chao, Chen Wanyi

机构信息

Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of the University of Electronic Science and Technology of China, Chengdu, China.

Department of Nuclear Protection Medicine, College of Preventive Medicine, Third Military Medical University, Chongqing, 400038, China.

出版信息

Pharmacol Rep. 2025 Jun;77(3):789-799. doi: 10.1007/s43440-025-00723-8. Epub 2025 Apr 11.

DOI:10.1007/s43440-025-00723-8

PMID:40214947

Abstract

BACKGROUND

The analgesic effect of transdermal fentanyl (TDF) differs among cancer pain patients. This study aims to investigate the relationship between clinical factors and pain relief when using TDF in cancer pain patients who rotate from oral opioids to TDF.

METHODS

A two-center retrospective study was conducted in Chongqing University Cancer Hospital and Sichuan Cancer Hospital, including adult cancer pain patients who rotated from oral opioids to TDF between 2018 and 2022. Based on the clinical characteristics, logistic regressions and directed acyclic graphs (DAG) were employed to identify significant factors influencing the efficacy of TDF. The study adhered to STROBE guidelines.

RESULTS

This survey included 359 patients, among them, 254 patients (70.8%) attained good pain relief after rotating to TDF. 59.3% of patients utilized TDF at standard dosage, while 24.8% used underdose TDF, with only 52.8% achieving adequate pain relief, significantly lower than other groups (p < 0.001). Initial univariable analysis of 22 clinical factors among the standard dose group showed that a higher body mass index (BMI, median 23.2 kg/m² vs. 21.0 kg/m², OR = 0.83 [0.75-0.91], p < 0.001) and the presence of lung cancer (OR = 0.31 [0.11-0.89], p = 0.030) predicted potentially unsatisfactory pain control after TDF treatment. Subsequently, a multivariable regression analysis based on DAG-directed factor selection identified BMI (OR = 0.82 [0.74-0.92], adjusted p < 0.01) as the only independent factor influencing TDF effectiveness.

CONCLUSIONS

Our study suggested that high BMI was a significant predictor of poor cancer pain relief when rotating from oral opioids to TDF, and provides a useful measurement of managing adult cancer pain when using TDF.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT06369961, registered on April 11, 2024; https://clinicaltrials.gov/study/NCT06369961 .

摘要

背景

透皮芬太尼（TDF）在癌症疼痛患者中的镇痛效果存在差异。本研究旨在探讨从口服阿片类药物转换为TDF的癌症疼痛患者中临床因素与疼痛缓解之间的关系。

方法

在重庆大学附属肿瘤医院和四川省肿瘤医院进行了一项双中心回顾性研究，纳入了2018年至2022年间从口服阿片类药物转换为TDF的成年癌症疼痛患者。基于临床特征，采用逻辑回归和有向无环图（DAG）来确定影响TDF疗效的显著因素。本研究遵循STROBE指南。

结果

本调查共纳入359例患者，其中254例患者（70.8%）转换为TDF后疼痛得到良好缓解。59.3%的患者使用标准剂量的TDF，24.8%的患者使用低剂量TDF，只有52.8%的患者疼痛得到充分缓解，显著低于其他组（p<0.001）。对标准剂量组的22个临床因素进行初步单变量分析显示，较高的体重指数（BMI，中位数23.2kg/m²对21.0kg/m²，OR=0.83[0.75-0.91]，p<0.001）和肺癌的存在（OR=0.31[0.11-0.89]，p=0.030）预测TDF治疗后疼痛控制可能不满意。随后，基于DAG导向的因素选择进行多变量回归分析，确定BMI（OR=0.82[0.74-0.92]，校正p<0.01）是影响TDF有效性的唯一独立因素。