卵巢癌患者化疗引起的贫血的治疗：使用红细胞生成刺激剂是否会降低生存率？

Treatment of chemotherapy-induced anemia in ovarian cancer patients: does the use of erythropoiesis-stimulating agents worsen survival?

机构信息

Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA.

出版信息

Int J Gynecol Cancer. 2012 Jun;22(5):786-91. doi: 10.1097/IGC.0b013e31825104f4.

DOI:10.1097/IGC.0b013e31825104f4

PMID:22552832

Abstract

OBJECTIVE

Considering the paucity of data relating erythropoiesis-stimulating agent (ESA) use to ovarian cancer survival, our objective was to evaluate the effect of ESA as used for the treatment of chemotherapy-induced anemia (CIA) on survival in ovarian cancer patients.

MATERIALS AND METHODS

A multi-institution retrospective chart review was performed on ovarian cancer patients. Data collection included patient demographic, surgicopathologic, chemotherapy, ESA, and survival data. Patients were stratified by ever-use of ESA and were compared using appropriate statistical methods.

RESULTS

A total of 581 patients were eligible for analysis with 39% (n = 229) patients with ever-use of ESA (ESA-YES) and 61% (n = 352) never-use ESA (ESA-NO). Mean age was 60.4 years with most patients having stage IIIC (60%) of papillary serous histological diagnosis (64%) with an optimal cytoreduction (67%). Median follow-up for the cohort was 27 months. Both ESA-YES and ESA-NO groups were similar regarding age, body mass index, race, stage, histological diagnosis, and debulking status. Compared with the ESA-NO group, ESA-YES patients were significantly more likely to experience recurrence (56% vs 80%, P < 0.001) and death (46% vs 59%, P = 0.002). Kaplan-Meier curves demonstrated a significant reduction in progression-free survival for ESA-YES patients (16 vs 24 months, P < 0.001); however, overall survival was statistically similar between the 2 groups (38 vs 46 months, P = 0.10). When stratifying by ever experiencing a CIA, ESA-YES patients demonstrated a significantly worse progression-free survival (17 vs 24 months, P = 0.02) and overall survival (37 vs 146 months, P < 0.001).

CONCLUSIONS

Our data evaluating the use of ESA as a treatment of CIA in ovarian cancer patients are similar to reports in other tumor sites. Considering that patients who used ESA were more likely to experience recurrence and death and to have decreased survival, the use of ESA in ovarian cancer patients should be limited.

摘要

目的

鉴于促红细胞生成素刺激剂（ESA）的使用与卵巢癌生存相关的数据稀缺，我们的目的是评估 ESA 作为治疗化疗诱导性贫血（CIA）对卵巢癌患者生存的影响。

材料和方法

对卵巢癌患者进行了多机构回顾性图表审查。数据收集包括患者的人口统计学、手术病理、化疗、ESA 和生存数据。根据 ESA 的使用情况对患者进行分层，并使用适当的统计方法进行比较。

结果

共有 581 名患者符合分析条件，其中 39%（n=229）患者曾使用 ESA（ESA-YES），61%（n=352）患者从未使用过 ESA（ESA-NO）。平均年龄为 60.4 岁，大多数患者为 IIIC 期（60%）的乳头状浆液性组织学诊断（64%），并进行了最佳减瘤术（67%）。该队列的中位随访时间为 27 个月。ESA-YES 组和 ESA-NO 组在年龄、体重指数、种族、分期、组织学诊断和减瘤状态方面相似。与 ESA-NO 组相比，ESA-YES 患者更有可能出现复发（56%比 80%，P<0.001）和死亡（46%比 59%，P=0.002）。Kaplan-Meier 曲线显示 ESA-YES 患者的无进展生存期显著缩短（16 比 24 个月，P<0.001）；然而，两组的总生存期统计学上无差异（38 比 46 个月，P=0.10）。按是否经历 CIA 分层，ESA-YES 患者的无进展生存期（17 比 24 个月，P=0.02）和总生存期（37 比 146 个月，P<0.001）均显著恶化。