Cascinu S, Barni S, Labianca R, Del Ferro E, Rocchi M B, Ligi M, Pessi M A, Cazzaniga M, Zamparelli G, Ardizzoia A, Ugolini G, Ghiandoni G, Luporini G, Catalano G
Division of Medical Oncology, Azienda Ospedaliera S. Salvatore, Ospedale di Muraglia, Pesaro, Italy.
Support Care Cancer. 1997 Jul;5(4):314-7. doi: 10.1007/s005200050079.
Diarrhea is one of the dose-limiting toxicities for administration of fluorouracil (5FU) in patients with colorectal cancer and can result in severe morbidity and mortality. No well-defined prognostic factors influencing 5FU-associated diarrhea have been identified, which means its occurrence is unforeseeable. The aim of this study was to check whether any characteristics related to patients or chemotherapy could allow the identification of subsets of patients at higher risk of developing diarrhea while receiving a regimen containing 5FU. A logistic regression analysis was performed with age, sex, site of primary tumor, presence of primary tumor, presence of colostomy, time since surgery, number of courses of chemotherapy, diarrhea in previous courses, season of treatment, and chemotherapeutic regimens used as model parameters to predict occurrence of diarrhea in 258 colorectal cancer patients receiving a 5FU-containing regimen. Presence of primary tumor (P = 0.004), previous episodes of chemotherapy-related diarrhea (P = 0.00005) and summer season (P = 0.014) were found to be significant risk factors for developing diarrhea. The other variables examined, such as age, sex, chemotherapeutic regimen, site of primary tumor, presence of colostomy, and time since surgery, were not significantly correlated to diarrhea. Chemotherapeutic regimen was the only parameter that allowed prediction of the severity of diarrhea: 5FU/6S-leucovorin/interferon caused more severe diarrhea, followed by 5FU/leucovorin weekly. Although the analysis of these clinical features does not seem to allow the definition of a well-defined subset of colorectal cancer patients at higher risk of 5FU-induced diarrhea, it can be recommended that patients with primary tumor, or who have experienced diarrhea in earlier courses of chemotherapy or are receiving treatment in summer should be carefully monitored, especially in the first cycles.
腹泻是结直肠癌患者使用氟尿嘧啶（5FU）进行治疗时的剂量限制性毒性之一，可导致严重的发病率和死亡率。目前尚未确定影响5FU相关性腹泻的明确预后因素，这意味着其发生难以预见。本研究的目的是检查与患者或化疗相关的任何特征是否能够识别出在接受含5FU方案治疗时发生腹泻风险较高的患者亚组。对258例接受含5FU方案治疗的结直肠癌患者进行了逻辑回归分析，将年龄、性别、原发肿瘤部位、原发肿瘤的存在、结肠造口术的存在、术后时间、化疗疗程数、既往疗程中的腹泻情况、治疗季节以及所用化疗方案作为预测腹泻发生的模型参数。结果发现，原发肿瘤的存在（P = 0.004）、既往化疗相关腹泻发作（P = 0.00005）和夏季（P = 0.014）是发生腹泻的显著危险因素。所检查的其他变量，如年龄、性别、化疗方案、原发肿瘤部位、结肠造口术的存在以及术后时间，与腹泻均无显著相关性。化疗方案是唯一能够预测腹泻严重程度的参数：5FU/6S-亚叶酸钙/干扰素引起的腹泻更严重，其次是每周一次的5FU/亚叶酸钙。尽管对这些临床特征的分析似乎无法明确界定出5FU诱导腹泻风险较高的结直肠癌患者亚组，但建议对有原发肿瘤、或在早期化疗疗程中经历过腹泻、或在夏季接受治疗的患者进行密切监测，尤其是在最初的几个周期。
