Real-world outcomes of chemotherapy for lung cancer patients undergoing hemodialysis: A multicenter retrospective cohort study (NEJ-042)
Real-world outcomes of chemotherapy for lung cancer patients undergoing hemodialysis: A multicenter retrospective cohort study (NEJ-042)
复制标题
接受血液透析的肺癌患者化疗的真实结果：多中心回顾性队列研究 (NEJ-042)
DOI：
10.1016/j.lungcan.2022.07.009
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发表时间：
2022
期刊：
影响因子：
5.3
通讯作者：
Seike Masahiro et al
中科院分区：
文献类型：
--
作者：
Minegishi Yuji;Sakakibara Rie;Seike Masahiro et al
恶性肿瘤是血液透析患者死亡的主要原因。这些患者的管理仍然具有挑战性，因为没有证据表明化疗是有益的，并缺乏实际的临床practice.MethodsThis多中心回顾性研究的信息包括血液透析患者被诊断为肺癌从2002年1月至2018年6月。我们回顾了他们的临床资料，包括肺癌和终末期肾病，方案，化疗的疗效和安全性，outcomes.ResultsA共162例患者在日本的22个机构进行了注册的患者特征。在158例符合条件的患者中，91例接受化疗（80例作为姑息化疗，11例作为放化疗），67例仅接受最佳支持治疗，无论癌症分期如何。接受细胞毒化疗的小细胞肺癌（SCLC）和非小细胞肺癌（NSCLC）患者的客观缓解率（ORR）和中位总生存期（OS）分别为68.1%、12.3个月和37.0%、8.5个月。EGFR突变型NSCLC患者接受EGFR酪氨酸激酶抑制剂（TKI）治疗的ORR和中位OS分别为44.4%和38.6个月。细胞毒性化疗诱导的治疗相关不良事件（3级或以上）为骨髓抑制和发热性中性粒细胞减少;在1例患者中观察到治疗相关死亡（TRD）。18例接受EGFR-TKI治疗的患者中有3例发生TRD。结论EGFR突变的NSCLC和SCLC血液透析患者应考虑化疗。然而，化疗对EGFR野生型NSCLC患者的生存益处尚不清楚;医生应仔细考虑是否为该患者亚群提供化疗。
IntroductionMalignant tumors are the major cause of death in hemodialysis patients. Management of these patients remains challenging as there is no evidence that chemotherapy is beneficial, and a lack of information about actual clinical practice.MethodsThis multicenter retrospective study included hemodialysis patients who were diagnosed with lung cancer from January 2002 to June 2018. We reviewed their clinical information including patient characteristics associated with lung cancer and end-stage renal disease, regimen, efficacy and safety of chemotherapy, and outcomes.ResultsA total of 162 patients from 22 institutions in Japan were registered. Of 158 eligible patients, 91 received chemotherapy (80 as palliative chemotherapy and 11 as chemoradiotherapy) and 67 received best supportive care only regardless of cancer stage. In small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) patients who received cytotoxic chemotherapy, the objective response rates (ORR) and median overall survival (OS) were 68.1 %, 12.3 months and 37.0 %, 8.5 months, respectively. The ORR and median OS in patients with EGFR-mutant NSCLC treated with EGFR-tyrosine kinase inhibitors (TKI) were 44.4 % and 38.6 months. The treatment-related adverse events (Grade 3 or higher) induced by cytotoxic chemotherapy were myelosuppression and febrile neutropenia; treatment-related death (TRD) was observed in one patient. TRD occurred in 3 of 18 patients who received EGFR-TKI.ConclusionChemotherapy should be considered for hemodialysis patients with EGFR-mutant NSCLC and SCLC. However, the survival benefits of chemotherapy for NSCLC patients with EGFR-wild type are unclear; physicians should carefully consider whether to offer chemotherapy to this patient subset.