Zhan Haiyan, Deng Yin, Huang Caifei, Yang Jing Xiang, Yang Jian
Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Pharmacy, Wuhan Jinyintan Hospital, Wuhan, China.
Medicine (Baltimore). 2025 Jun 20;104(25):e42881. doi: 10.1097/MD.0000000000042881.
This study aims to analyze the risk factors of docetaxel-induced liver injury to provide evidence for the clinical prevention and treatment of docetaxel-induced liver injury. A retrospective analysis of patients who received docetaxel chemotherapy regimen from January 2017 to April 2018 in Renmin Hospital of Wuhan University was conducted. Univariate analysis and multivariate logistic regression analysis with the forward stepwise method were used to assess the risk factors associated with liver injury induced by docetaxel. Receiver-operator characteristic curve analysis was performed to calculate the area under the receiver-operator characteristic curve (AUC). In the study, 223 (7.88%) patients were diagnosed as docetaxel-induced liver injury, among which the patients with ovarian cancer had the highest incidence rate (8.33%). By logistic regression analysis, hepatitis B virus carrier, diabetes, docetaxel plus nedaplatin, docetaxel plus capecitabine, docetaxel plus epirubicin, and docetaxel plus cyclophosphamide chemotherapy regimens, were independently associated with drug-induced liver injury during receiving chemotherapy, respectively. Among them, diabetes and docetaxel plus cyclophosphamide were protective factors, but the others were risk factors. Further analysis by the risk score and AUC showed that those factors contributed to an AUC of 0.693 (95% confidence interval = 0.660-0.727), with a predictive sensitivity of 70.9% and specificity of 61.6%. Docetaxel-induced liver injury with a relatively higher incidence should be addressed among ovary cancer patients. The predominant risk factors of docetaxel-induced liver injury included hepatitis B virus carrier and docetaxel combination regimens, and the protective factor was diabetic patients. Among these therapeutic combination regimens, docetaxel plus epirubicin, docetaxel plus nedaplatin, and docetaxel plus capecitabine could significantly increase the occurrence of docetaxel-induced liver injury during hospitalization respectively, while docetaxel plus cyclophosphamide regime might be safer. Therefore, for patients with these risk factors, it might be advisable to actively consider optimum management to reduce the occurrence of docetaxel-induced liver injury during hospitalization, particularly hepatic function test.
本研究旨在分析多西他赛所致肝损伤的危险因素,为临床预防和治疗多西他赛所致肝损伤提供依据。对武汉大学人民医院2017年1月至2018年4月接受多西他赛化疗方案的患者进行回顾性分析。采用单因素分析和向前逐步法的多因素logistic回归分析来评估与多西他赛所致肝损伤相关的危险因素。进行受试者工作特征曲线分析以计算受试者工作特征曲线下面积(AUC)。在该研究中,223例(7.88%)患者被诊断为多西他赛所致肝损伤,其中卵巢癌患者的发病率最高(8.33%)。通过logistic回归分析,乙肝病毒携带者、糖尿病、多西他赛联合奈达铂、多西他赛联合卡培他滨、多西他赛联合表柔比星以及多西他赛联合环磷酰胺化疗方案,分别与化疗期间药物性肝损伤独立相关。其中,糖尿病和多西他赛联合环磷酰胺是保护因素,而其他则是危险因素。通过风险评分和AUC进一步分析表明,这些因素导致AUC为0.693(95%置信区间=0.660 - 0.727),预测敏感性为70.9%,特异性为61.6%。卵巢癌患者中多西他赛所致肝损伤发病率相对较高,应予以关注。多西他赛所致肝损伤的主要危险因素包括乙肝病毒携带者和多西他赛联合方案,保护因素为糖尿病患者。在这些治疗联合方案中,多西他赛联合表柔比星、多西他赛联合奈达铂以及多西他赛联合卡培他滨分别可显著增加住院期间多西他赛所致肝损伤的发生,而多西他赛联合环磷酰胺方案可能更安全。因此,对于有这些危险因素的患者,建议积极考虑最佳管理措施以减少住院期间多西他赛所致肝损伤的发生,尤其是肝功能检查。