摘要
目的 :分析软组织肉瘤患者化疗后预防性使用聚乙二醇化重组人粒细胞集落刺激因子(pegylated recombinant human granulocyte colony-stimulating factor,PEG-rhG-CSF)的临床疗效。方法 :收集复旦大学附属中山医院肿瘤内科2016年7月-2019年7月确诊为软组织肉瘤,且化疗后接受PEG-rhG-CSF治疗以预防性提升体内白细胞数的患者资料,并进行临床分析。结果 :共有107例软组织肉瘤患者使用了PEG-rhG-CSF进行预防性提升体内白细胞数治疗。最终中性粒细胞减少发生率为48.6%,其中3~4级发生率为28.0%,粒细胞减少性发热(febrile neutropenia,FN)发生率为4.7%;男女患者发生率分别为52.8%和44.4%,老年患者(≥65岁)与中青年患者(<65岁)发生率分别为41.7%和49.5%,差异均无统计学意义(P值均> 0.05)。含有异环磷酰胺和多柔比星的IA化疗方案毒性较大,发生4例FN,而且中性粒细胞减少发生率为50.9%。接受重大手术(3~4级)和未接受重大手术(1~2级和未手术)患者中性粒细胞减少发生率分别为60.0%和34.0%,差异有统计学意义(P <0.05)。接受放疗者和未接受放疗者的中性粒细胞减少发生率分别为70.0%和43.7%,有统计学意义(P <0.05)。结论 :预防性使用PEG-rh G-CSF可避免绝大多数软组组肉瘤患者在化疗后发生严重骨髓毒性。然而,接受异环磷酰胺和多柔比星药物为基础的化疗方案,以及接受过重大手术和放疗的患者,中性粒细胞减少的发生率仍然较高,值得关注。
Objective: To analyze the clinical effect of prophylactic use of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) after chemotherapy in patients with soft tissue sarcoma.Methods: The clinical data of the patients with soft tissue sarcoma who were diagnosed in the Oncology Department of Zhongshan Hospital Affiliated to Fudan Universtiy from July 2016 to July 2019, and received the preventive treatment of PEG-rhG-CSF after chemotherapy to prevent the increase of leukocyte count in vivo, was collected and analyzed.Results: A total of 107 patients with soft tissue sarcoma were treated with PEG-rhG-CSF after chemotherapy. The incidence of neutropenia was 48.6%(52/107), in which the incidence of grade 3-4 neutropenia was 28.0%(30/107), and the incidence of febrile neutropenia(FN) was 4.7%(5/107). The incidence of neutropenia in male or female patients was 52.8%(28/53) or 44.4%(24/54), respectively;there was no significant difference(P > 0.05). The incidence of neutropenia in elderly patients(≥ 65 years old) or young and mid-aged patients(< 65 years old) was 41.7%(5/12) or 49.5%(47/95), respectively;there was no significant difference(P > 0.05). The use of IA chemotherapy with ifosfamide and doxorubicin was more toxic, the incidence of neutropenia was 50.9%(27/53) with 4 cases of FN. In the patients who received major surgery(grade 3-4) or those who did not receive major surgery(grade 1-2 and no surgery), the incidence of neutropenia was 60.0%(36/60) or 34.0%(16/47), respectively;there was significant difference(P < 0.05). In the patients who received radiotherapy or those without radiotherapy, the incidence of neutropenia was 70.0%(14/20) or 43.7%(38/87), respectively;there was significant difference(P < 0.05). Conclusion: The prophylactic use of PEG-rh G-CSF can avoid severe myelotoxicity in the majority of patients with soft tissue sarcoma. However, the risk of neutropenia is still high in the patients who received chemotherapy based on ifosfamide and anthracyclines, as well as in the patients who have received radiotherapy and major surgery in the past. All these are worthy of concern.
作者
申锋
周宇红
何健
郭曦
冯艺
庄荣源
SHEN Feng;ZHOU Yuhong;HE Jian;GUO Xi;FENG Yi;ZHUANG Rongyuan(Department of Medical Oncology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Radiotherapy,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《肿瘤》
CAS
CSCD
北大核心
2020年第5期355-360,共6页
Tumor
