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围手术期辅助多西他赛与紫杉醇治疗乳腺癌的眼部不良事件:倾向评分重叠加权分析

Ocular adverse events of perioperative adjuvant docetaxel vs paclitaxel for breast cancer: propensity-score overlap-weighted analysis.

作者信息

Iwai Chikako, Miyawaki Atsushi, Konishi Takaaki, Okada Akira, Fujita Asahi, Jo Taisuke, Yasunaga Hideo

机构信息

Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.

Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

出版信息

Breast Cancer Res Treat. 2025 Jul;212(1):173-182. doi: 10.1007/s10549-025-07720-8. Epub 2025 May 13.

Abstract

BACKGROUND

Taxanes are known to be associated with several ocular adverse events; however, large-scale data comparing the risk of ocular adverse events between the two commonly used taxanes, docetaxel (DTX) and paclitaxel (PTX), remain limited. Therefore, we aimed to compare the risks of epiphora, cystoid macular edema, and optic neuropathy between DTX- and PTX-based chemotherapy regimens.

METHODS

Using a nationwide claims database in Japan, we identified 6038 patients who initiated neoadjuvant or adjuvant taxane-based chemotherapy for breast cancer between April 2014 and November 2022. Data analysis was conducted in 2024. This study was conducted across multiple referral centers and community hospitals in Japan, providing a comprehensive view of taxane-based chemotherapy practices in diverse healthcare settings. Participants included 6038 patients diagnosed with breast cancer who initiated neoadjuvant or adjuvant taxane-based chemotherapy. Eligibility criteria included female patients aged 18 years or older. Participants were selected from a nationwide claims database using a consecutive sampling method. Patients who received DTX-based chemotherapy (DTX group) were compared with those who received PTX-based chemotherapy (PTX group). After adjusting for potential confounders using a propensity score-overlap weighting method, we estimated the incidence of the three ocular adverse events and hazard ratios (HRs) using Cox proportional hazards regression models.

RESULTS

Among the 6038 eligible patients, 3829 were in the DTX group and 2209 in the PTX group. The adjusted HR for epiphora in the DTX group was 1.69 [95% confidence interval (CI), 1.17 to 2.45] compared with the PTX group. For cystoid macular edema and optic neuropathy, the adjusted HRs were 0.74 (95% CI, 0.52 to 1.04) and 0.72 (0.47 to 1.11), respectively. The composite incidence of epiphora, cystoid macular edema, and optic neuropathy did not differ significantly between the DTX and PTX groups.

CONCLUSION

Among patients receiving taxane-based chemotherapy for breast cancer, DTX was associated with a higher risk of epiphora compared with PTX. However, the incidence rates of cystoid macular edema and optic neuropathy did not differ significantly between the two groups. These findings offer valuable insights into the ocular adverse event profile of taxane-based chemotherapy in patients with breast cancer.

摘要

背景

已知紫杉烷类药物与多种眼部不良事件相关;然而,比较两种常用紫杉烷类药物多西他赛(DTX)和紫杉醇(PTX)之间眼部不良事件风险的大规模数据仍然有限。因此,我们旨在比较基于DTX和PTX的化疗方案中泪溢、黄斑囊样水肿和视神经病变的风险。

方法

利用日本全国性的索赔数据库,我们确定了2014年4月至2022年11月期间开始接受新辅助或辅助紫杉烷类药物化疗的6038例乳腺癌患者。数据分析于2024年进行。本研究在日本的多个转诊中心和社区医院开展,全面了解了不同医疗环境中基于紫杉烷类药物的化疗实践。参与者包括6038例诊断为乳腺癌并开始接受新辅助或辅助紫杉烷类药物化疗的患者。纳入标准包括18岁及以上的女性患者。参与者采用连续抽样方法从全国性索赔数据库中选取。将接受基于DTX化疗的患者(DTX组)与接受基于PTX化疗的患者(PTX组)进行比较。使用倾向评分重叠加权法调整潜在混杂因素后,我们采用Cox比例风险回归模型估计了三种眼部不良事件的发生率和风险比(HRs)。

结果

在6038例符合条件的患者中,DTX组有3829例,PTX组有2209例。与PTX组相比,DTX组泪溢的调整后HR为1.69 [95%置信区间(CI),1.17至2.45]。对于黄斑囊样水肿和视神经病变,调整后的HR分别为0.74(95%CI,0.52至1.04)和0.72(0.47至1.11)。DTX组和PTX组泪溢、黄斑囊样水肿和视神经病变的综合发生率无显著差异。

结论

在接受紫杉烷类药物化疗的乳腺癌患者中,与PTX相比,DTX与泪溢风险较高相关。然而,两组之间黄斑囊样水肿和视神经病变的发生率无显著差异。这些发现为乳腺癌患者基于紫杉烷类药物的化疗的眼部不良事件情况提供了有价值的见解。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bcb1/12086119/cc72a539b279/10549_2025_7720_Fig1_HTML.jpg

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