接受5-氟尿嘧啶联合顺铂同步放化疗的食管癌患者发热性中性粒细胞减少相关危险因素

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中文摘要

目的： 识别接受首个周期根治性同步放化疗（5-氟尿嘧啶联合顺铂及同步放疗，FP+R治疗）的食管癌患者发热性中性粒细胞减少（FN）的危险因素。
方法： 我们开展了一项单中心回顾性队列研究，纳入2011年4月至2023年6月期间在大分大学医院开始FP+R治疗的患者。主要结局为第1周期FN发生。采用单因素检验和多变量logistic回归[强制进入：年龄、C反应蛋白（CRP）、预后营养指数（PNI）、吞咽困难]评估与FN发生的关联。进行受试者工作特征（ROC）分析以评估基线CRP对FN的预测性能。
结果： 在研究的120例患者中，第一周期期间发生≥3级中性粒细胞减少37例（30.8%），FN 14例（11.7%）。在多变量分析中，较高的基线CRP与FN风险增加独立相关[比值比（OR）1.790；95%置信区间（CI）1.120-2.850；p = 0.014]，而吞咽困难显示非显著关联（OR 2.890；p = 0.145）。年龄和PNI不是独立预测因素。基线CRP的ROC分析得出ROC曲线下面积为0.699（95% CI 0.520-0.877；p = 0.021），最佳截断值为0.68 mg/dL（敏感性61.54%；特异性70.65%）。
结论： 基线全身炎症（以CRP升高为指标）是FP+R治疗期间FN发生的独立危险因素。尽管该方案具有中等FN风险，但治疗前CRP升高的患者可能需要更密切的监测。该生物标志物可能有助于临床医生在常规患者特异性因素之外进行更全面的风险评估。

英文摘要

PURPOSE: To identify risk factors for febrile neutropenia (FN) in patients with esophageal cancer receiving the first cycle of definitive chemoradiotherapy with 5-fluorouracil plus cisplatin and concurrent radiotherapy (FP+R therapy).
METHODS: We conducted a retrospective single-center cohort study of patients who started FP+R at Oita University Hospital between April 2011 and June 2023. The primary outcome was FN onset in cycle 1. Univariate tests and multivariable logistic regression [forced entry: age, C-reactive protein (CRP), prognostic nutritional index (PNI), dysphagia] were used to evaluate association with FN development. Receiver operating characteristic (ROC) analysis was conducted to evaluate the predictive performance of baseline CRP for FN.
RESULTS: Among 120 patients studied, grade ≥ 3 neutropenia occurred in 37 (30.8%) and FN in 14 (11.7%) during the first cycle. In multivariable analysis, higher baseline CRP was independently associated with increased FN risk [odds ratio (OR) 1.790; 95% confidence interval (CI) 1.120-2.850; p = 0.014], whereas dysphagia showed a non-significant association (OR 2.890; p = 0.145). Age and PNI were not independent predictors. ROC analysis for baseline CRP yielded area under the ROC curve of 0.699 (95% CI 0.520-0.877; p = 0.021) with optimal cut-off value of 0.68 mg/dL (sensitivity 61.54%; specificity 70.65%).
CONCLUSION: Baseline systemic inflammation, indicated by elevated CRP, is an independent risk factor for FN development during FP+R therapy. Despite the regimen having an intermediate FN risk, patients with elevated pre-treatment CRP may need closer monitoring. This biomarker may help clinicians perform a more comprehensive risk assessment alongside conventional patient-specific factors.