乳腺癌化疗后贫血发生率及相关危险因素分析
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摘要
目的探讨乳腺癌患者化疗后贫血的发生率及相关危险因素。方法对2015年1月～2016年12月期间于笔者医院及河南省肿瘤医院乳腺外科住院的583例乳腺癌患者的临床资料进行回顾性分析,统计化疗后血红蛋白(Hb)水平,进行χ2检验及多因素Logistic回归分析探讨贫血发生的危险因素,并分析贫血的诊治情况。结果 583例乳腺癌有328例发生贫血,贫血的发生率为56. 26%;贫血的危险因素为病理分期高、多周期化疗、Hb <135g/L、绝经。结论乳腺癌化疗后贫血发生率较高,可根据患者入院时Hb水平、病理分期、绝经、化疗方案(周期),预测贫血发生情况,给予重视。
Objective To investigate the incidence of anemia and related risk factors in patients with breast cancer after chemotherapy. Methods The clinical data of 583 breast cancer patients hospitalized in breast surgery department of our hospital and Henan Cancer Hospital during January 2015 to December 2016 was retrospectively analyzed. We performed Hb examination after chemotherapy. X2 test and multiple factors Logistic regression analysis was used to explore the risk factors for anemia,and to analyze the diagnosis and treatment of anemia. Results Totally 328 of the 583 breast cancer patients( 56. 26%) developed anemia. The risk factors for anemia included high pathologic stage,multi-cycle chemotherapy,Hb < 135 g/L,menopause. Conclusion The incidence of anemia in patients with breast cancer after chemotherapy is high. We can predict the development of anemia based on the Hb level,pathological stage,menopause,chemotherapy cycle( protocol) and we should pay attention to it.
Objective To investigate the incidence of anemia and related risk factors in patients with breast cancer after chemotherapy. Methods The clinical data of 583 breast cancer patients hospitalized in breast surgery department of our hospital and Henan Cancer Hospital during January 2015 to December 2016 was retrospectively analyzed. We performed Hb examination after chemotherapy. X2 test and multiple factors Logistic regression analysis was used to explore the risk factors for anemia,and to analyze the diagnosis and treatment of anemia. Results Totally 328 of the 583 breast cancer patients( 56. 26%) developed anemia. The risk factors for anemia included high pathologic stage,multi-cycle chemotherapy,Hb < 135 g/L,menopause. Conclusion The incidence of anemia in patients with breast cancer after chemotherapy is high. We can predict the development of anemia based on the Hb level,pathological stage,menopause,chemotherapy cycle( protocol) and we should pay attention to it.
引文
1蔡耿喜,刘情,姚广裕,等. 400例早期乳腺癌化疗过程中贫血发生率及相关因素[J].实用医学杂志,2015,31(23):3898-3900
2 National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology:cancer-and chemotherapy induced anemia.V2. 2016[EB/OL].[2017-01-05]. https://www. nccn. org/professionals/physician_gls/f_guidelines. asp
3 Abdel-Razeq H,Abbasi S,Saadi I,et al. Intravenous iron monotherapy for the treatment of non-iron-deficiency anemia in cancer patients undergoing chemotherapy:a pilot study[J]. Drug Des Devel Ther,2013,30(7):939-944
4 Hilarius DL,Kloeg PH,van der Wall E,et al. Cancer-related fatigue:clinical practice versus practice guidelines[J]. Support Care Cancer,2011,19(4):531-538
5 Chaumard N,Limat S,Villanueva C,et al. Incidence and risk factors of anemia in patients with early breast cancer treated by adjuvant chemotherapy[J]. Breast,2012,21(4):464-467
6 Lee CT,Boss MK,Dewhirst MW,et al. Imaging tumor hypoxia to advance radiation oncology[J]. Antioxid Redox Sign,2014,21(2):313-337
7 Walsh JC,Lebedev A,Aten E,et al. The clinical importance of assessing tumor hypoxia:relationship of tumor hypoxia to prognosis and therapeutic opportunities[J]. Antioxid Redox Sign,2014,21(10):1516-1554
8 Zhang F,Cheng F,Cao L,et al. A retrospective study:the prevalence and prognostic value of anemia in patients undergoing radiotherapy for esophageal squamous cell carcinoma[J]. World J Surg Oncol,2014,12(244):1-7
9 高艳,许崇安,刘殊,等.癌性贫血对恶性肿瘤患者生活质量及生存期的影响[J].中华肿瘤防治杂志,2009,24(12):1957-1960
10 苏贺,张凌云,刘云鹏.老年恶性肿瘤患者术后化疗相关性贫血的临床分析[J].中华肿瘤杂志,2015,37(4):290-292
11 Dranitsaris G,Clcmons M,Verma S,et al. Chemotherapy-induced anaemia during adjuvant treatment for breast cancer:development of a prediction model[J]. Lancet Oncol,2005,6(11):856-863
12 赖晓嵘,黎莹,杨冬阳等.消化道肿瘤患者红细胞生成素水平的检测及其临床意义[J]肿瘤代谢与营养电子杂志,2015,2(1):39-41
13朱辞,王岩,葛飞娇,等.中国胃癌患者贫血的多中心前瞻性临床研究[J].中国肿瘤临床与康复,2014,21(8):897-901
14 马军,王杰军,张力,等.肿瘤相关性贫血临床实践指南(2015-2016版)[J].中国实用内科杂志,2015,35(11):921-930
15 钱朋飞,邹燕鹏,黎冠宏,等.小牛脾提取物对晚期乳腺癌化疗性贫血及免疫功能的影响[J].中国临床医生杂志,2017,45(2):66-70
16 Musallam KM,Tamim HM,Richards T,et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery:a retrospective cohort study[J]. Lancet,2011,378(9800):1396-1407
17 刘彤华,梁勇,邵宗鸿.非血液系统肿瘤并发贫血530例临床分析[J].中国综合临床,2012,28(7):682-685
18 Sideris M,Adams K,Moorhead J,et al. BRAF V600E mutation in colorectal cancer is associated with right-sided tumours and iron deficiency anaemia[J]. Anticancer Res,2015,35(4):2345-2350
19 Qiu L,Wang DR,Zhang XY,et al. Impact of perioperative blood transfusion on immune function and prognosis in colorectal cancer patients[J]. Transfus Apher Sci,216,54(2):235-241
20 Gafter-Gvili A,Rozen-Zvi B,Vidal L,et al. Intravenous iron supplementation for the treatment of chemotherapy-induced anaemia-systematic review and meta-analysis of randomised controlled trials[J]. Acta Oncol,2013,52(1):18-29
2 National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology:cancer-and chemotherapy induced anemia.V2. 2016[EB/OL].[2017-01-05]. https://www. nccn. org/professionals/physician_gls/f_guidelines. asp
3 Abdel-Razeq H,Abbasi S,Saadi I,et al. Intravenous iron monotherapy for the treatment of non-iron-deficiency anemia in cancer patients undergoing chemotherapy:a pilot study[J]. Drug Des Devel Ther,2013,30(7):939-944
4 Hilarius DL,Kloeg PH,van der Wall E,et al. Cancer-related fatigue:clinical practice versus practice guidelines[J]. Support Care Cancer,2011,19(4):531-538
5 Chaumard N,Limat S,Villanueva C,et al. Incidence and risk factors of anemia in patients with early breast cancer treated by adjuvant chemotherapy[J]. Breast,2012,21(4):464-467
6 Lee CT,Boss MK,Dewhirst MW,et al. Imaging tumor hypoxia to advance radiation oncology[J]. Antioxid Redox Sign,2014,21(2):313-337
7 Walsh JC,Lebedev A,Aten E,et al. The clinical importance of assessing tumor hypoxia:relationship of tumor hypoxia to prognosis and therapeutic opportunities[J]. Antioxid Redox Sign,2014,21(10):1516-1554
8 Zhang F,Cheng F,Cao L,et al. A retrospective study:the prevalence and prognostic value of anemia in patients undergoing radiotherapy for esophageal squamous cell carcinoma[J]. World J Surg Oncol,2014,12(244):1-7
9 高艳,许崇安,刘殊,等.癌性贫血对恶性肿瘤患者生活质量及生存期的影响[J].中华肿瘤防治杂志,2009,24(12):1957-1960
10 苏贺,张凌云,刘云鹏.老年恶性肿瘤患者术后化疗相关性贫血的临床分析[J].中华肿瘤杂志,2015,37(4):290-292
11 Dranitsaris G,Clcmons M,Verma S,et al. Chemotherapy-induced anaemia during adjuvant treatment for breast cancer:development of a prediction model[J]. Lancet Oncol,2005,6(11):856-863
12 赖晓嵘,黎莹,杨冬阳等.消化道肿瘤患者红细胞生成素水平的检测及其临床意义[J]肿瘤代谢与营养电子杂志,2015,2(1):39-41
13朱辞,王岩,葛飞娇,等.中国胃癌患者贫血的多中心前瞻性临床研究[J].中国肿瘤临床与康复,2014,21(8):897-901
14 马军,王杰军,张力,等.肿瘤相关性贫血临床实践指南(2015-2016版)[J].中国实用内科杂志,2015,35(11):921-930
15 钱朋飞,邹燕鹏,黎冠宏,等.小牛脾提取物对晚期乳腺癌化疗性贫血及免疫功能的影响[J].中国临床医生杂志,2017,45(2):66-70
16 Musallam KM,Tamim HM,Richards T,et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery:a retrospective cohort study[J]. Lancet,2011,378(9800):1396-1407
17 刘彤华,梁勇,邵宗鸿.非血液系统肿瘤并发贫血530例临床分析[J].中国综合临床,2012,28(7):682-685
18 Sideris M,Adams K,Moorhead J,et al. BRAF V600E mutation in colorectal cancer is associated with right-sided tumours and iron deficiency anaemia[J]. Anticancer Res,2015,35(4):2345-2350
19 Qiu L,Wang DR,Zhang XY,et al. Impact of perioperative blood transfusion on immune function and prognosis in colorectal cancer patients[J]. Transfus Apher Sci,216,54(2):235-241
20 Gafter-Gvili A,Rozen-Zvi B,Vidal L,et al. Intravenous iron supplementation for the treatment of chemotherapy-induced anaemia-systematic review and meta-analysis of randomised controlled trials[J]. Acta Oncol,2013,52(1):18-29