Predictors of reduced dose intensity in patients with early-stage breast cancer receiving adjuvant chemotherapy
Predictors of reduced dose intensity in patients with early-stage breast cancer receiving adjuvant chemotherapy
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DOI：
10.1007/s10549-006-9254-4
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发表时间：
2006-12-01
影响因子：
3.8
通讯作者：
Lyman, Gary H.
中科院分区：
文献类型：
--
作者：
Shayne, Michelle;Crawford, Jeffrey;Lyman, Gary H.
背景 这项回顾性研究旨在确定早期乳腺癌 (ESBC) 女性辅助化疗剂量强度降低的危险因素。方法 1998 年至 2002 年间对 190 个社区肿瘤诊所进行了一项全国性调查，回顾性收集了 3,707 名接受辅助化疗的 ESBC 患者的数据。终点包括剂量强度降低、相对剂量强度 (RDI) < 85% 以及化疗剂量延迟 >= 7 天和剂量减少 >= 15% 的发生率。还评估了人口统计学和临床特征、发热性中性粒细胞减少症 (FN) 的发生率以及粒细胞集落刺激因子 (G-CSF) 的使用模式。 结果 所有方案的平均 RDI 为 88%，其中 30% 的患者接受的方案标准<85%。平均 RDI 的减少量中有 17% 是从治疗开始就计划好的，13% 是计划外的。在单变量分析中，RDI减少的显着预测因素为：年龄>= 65岁（41%，P < 0.001）、体表面积（BSA）> 2 m(2)（37%，P < 0.001）、淋巴结阴性（33%，P < 0.001）、FN（36%，P = 0.013）和合并症（40%，P = 0.013），特别是肾脏疾病（86%，P = 0.004）。预防性 G-CSF 剂量减少较少（24%，P < 0.001）。在多变量分析中，RDI 减少的重要独立预测因素包括：高龄、BSA 增加、合并症、基于蒽环类药物的治疗方案、28 天治疗方案和 FN，而主要 G-CSF 预防与风险显着降低相关。 结论 相当一部分可能可治愈的 ESBC 患者继续经历计划内和计划外的 RDI 减少。
Background This retrospective study was undertaken to define risk factors for reductions in dose intensity of adjuvant chemotherapy in women with early stage breast cancer (ESBC).Methods A nationwide survey of 190 community oncology practices was conducted between 1998 and 2002 with data collected retrospectively on 3,707 patients treated with adjuvant chemotherapy for ESBC. End points included reductions in dose intensity, delivered relative dose intensity (RDI) < 85%, and the incidence of chemotherapy dose delays >= 7 days and dose reduction >= 15%. Demographic and clinical characteristics, incidence of febrile neutropenia (FN), and patterns of use of granulocyte colony-stimulating factor (G-CSF) were also assessed.Results Average RDI for all regimens was 88%, with 30% of patients receiving < 85% of standard for their regimen. Seventeen percent of the reduction in average RDI was planned from the start of therapy, and 13% was unplanned. In univariate analysis, significant predictors of reduced RDI were: age >= 65 years (41%, P < 0.001), body surface area (BSA) > 2 m(2) (37%, P < 0.001), negative lymph nodes (33%, P < 0.001), FN (36%, P = 0.013), and comorbidities (40%, P = 0.013), particularly renal disease (86%, P = 0.004). Dose reduction was less with prophylactic G-CSF (24%, P < 0.001). In multivariate analysis, significant independent predictors of reduced RDI included: advanced age, greater BSA, comorbidities, anthracycline-based regimens, a 28-day schedule and FN, while primary G-CSF prophylaxis was associated with a significant reduction in risk.Conclusions A significant proportion of patients with potentially curable ESBC continue to experience planned and unplanned reductions in RDI.