Chemotherapy-induced neutropenia as a prognostic factor in advanced non-small-cell lung cancer: results from Japan Multinational Trial Organization LC00-03.
Chemotherapy-induced neutropenia as a prognostic factor in advanced non-small-cell lung cancer: results from Japan Multinational Trial Organization LC00-03.
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DOI：
10.1038/sj.bjc.6605348
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发表时间：
2009-11-03
影响因子：
8.8
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中科院分区：
文献类型：
--
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中性粒细胞减少是化疗常见的不良反应。我们评估了化疗诱导的中性粒细胞减少是否可以作为非小细胞肺癌（NSCLC）患者生存的预测因子。在一项随机对照试验中，共对387例接受化疗（长春瑞滨和吉西他滨，随后多西他赛，或紫杉醇和卡铂）的化疗初治患者进行了评价。比例风险回归模型用于研究化疗诱导的中性粒细胞减少和肿瘤反应对总生存期的影响。使用地标分析来减少更严重的中性粒细胞减少症的偏倚，该偏倚是由更长的生存期所允许的更多治疗周期引起的，其中排除了在开始化疗后126天内死亡的患者。与无中性粒细胞减少的患者相比，1 - 2级中性粒细胞减少或3 - 4级中性粒细胞减少患者的校正风险比分别为0.59（95%置信区间（CI），0.36-0.97）和0.71（95% CI，0.49-1.03）。发生中性粒细胞减少伴疾病稳定（SD）的患者与无中性粒细胞减少伴部分缓解（PR）的患者之间的风险比无显著差异。化疗诱导的中性粒细胞减少症是晚期NSCLC患者生存率提高的预测因子。根据化疗诱导的毒性指导早期剂量增加的前瞻性随机试验是必要的。
Neutropenia is a common adverse reaction of chemotherapy. We assessed whether chemotherapy-induced neutropenia could be a predictor of survival for patients with non-small-cell lung cancer (NSCLC). A total of 387 chemotherapy-naïve patients who received chemotherapy (vinorelbine and gemcitabine followed by docetaxel, or paclitaxel and carboplatin) in a randomised controlled trial were evaluated. The proportional-hazards regression model was used to examine the effects of chemotherapy-induced neutropenia and tumour response on overall survival. Landmark analysis was used to lessen the bias of more severe neutropenia resulting from more treatment cycles allowed by longer survival, whereby patients who died within 126 days of starting chemotherapy were excluded. The adjusted hazard ratios for patients with grade-1 to 2 neutropenia or grade-3 to 4 neutropenia compared with no neutropenia were 0.59 (95% confidence interval (CI), 0.36–0.97) and 0.71 (95% CI, 0.49–1.03), respectively. The hazard ratios did not differ significantly between the patients who developed neutropenia with stable disease (SD), and those who lacked neutropenia with partial response (PR). Chemotherapy-induced neutropenia is a predictor of better survival for patients with advanced NSCLC. Prospective randomised trials of early-dose increases guided by chemotherapy-induced toxicities are warranted.
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影响因子：
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