Impact of Chemotherapy Dosing on Ovarian Cancer Survival According to Body Mass Index
Impact of Chemotherapy Dosing on Ovarian Cancer Survival According to Body Mass Index
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DOI：
10.1001/jamaoncol.2015.1796
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发表时间：
2015-09-01
期刊：
影响因子：
28.4
通讯作者：
Kushi, Lawrence H.
中科院分区：
文献类型：
--
作者：
Bandera, Elisa V.;Lee, Valerie S.;Kushi, Lawrence H.
肥胖患者的最佳化疗剂量仍不确定，实践中存在差异。剂量减少策略通常用于避免化疗毒性，但最近美国临床肿瘤学会指南建议全剂量。目的评估体重指数（BMI）对化疗剂量的影响和剂量减少对卵巢癌生存率的影响。和参与者Kaiser Permanente北方加州（KPNC）队列研究2000年1月至2013年3月诊断的原发性浸润性上皮性卵巢癌患者的卫生保健环境。分析的重点是806例患者接受辅助一线治疗的卡铂和紫杉醇与curement.Main结局和措施总体和卵巢癌特异性死亡率。死亡通过KPNC死亡率联动系统确定，中位随访时间为52.5个月。风险比（HR）和95%CI估计比例风险回归，占预后变量，包括诊断时的年龄，种族，阶段，等级，组织学类型，化学毒性作用，合并症，癌抗原125水平，BMI在diagnosis.RESULTS剂量减少的最强预测因子是高BMI。与正常体重的女性相比，III级肥胖女性接受的紫杉醇和卡铂剂量（mg/kg体重）分别低38%和45%（P
IMPORTANCE Optimal chemotherapy dosing in obese patients remains uncertain, with variation in practice. Dose reduction strategies are often used to avoid chemotoxicity, but recent American Society of Clinical Oncology guidelines recommend full dose.OBJECTIVE To evaluate the impact of body mass index (BMI) on chemotherapy dosing and of dose reduction on ovarian cancer survival.DESIGN, SETTING, AND PARTICIPANTS Cohort study in Kaiser Permanente Northern California (KPNC) health care setting of patients with primary invasive epithelial ovarian cancers diagnosed from January 2000 through March 2013. Analyses focused on 806 patients receiving adjuvant first-line therapy of carboplatin and paclitaxel with curative intent.MAIN OUTCOMES AND MEASURES Overall and ovarian cancer-specific mortality. Deathswere identified through the KPNC Mortality Linkage System, with median follow-up of 52.5 months. Hazard ratios (HRs) and 95% CIs were estimated from proportional hazards regression, accounting for prognostic variables including age at diagnosis, race, stage, grade, histologic type, chemotoxic effects, comorbidities, cancer antigen 125 levels, and BMI at diagnosis.RESULTS The strongest predictor of dose reduction was a high BMI. Compared with normal-weight women, obese class III women received 38% and 45% lower doses in milligrams per kilogram of body weight of paclitaxel and carboplatin, respectively (P