高剂量甲氨蝶呤治疗骨肉瘤致白细胞降低的风险因素分析  

Analysis of risk factors in leukopenia after high-dose methotrexate treatment for osteosarcoma

作　　者：夏文彬 吴海啸 胡阳 张瑾 张超 Wenbin Xia;Haixiao Wu;Yang Hu;Jin Zhang;Chao Zhang(Department of Cancer Biobank,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center of Cancer,Tianjin Key Laboratory of Cancer Prevention and Therapy,Tianjin’s Clinical Research Center for Cancer,Tianjin 300060,China;Department of Bone and Soft Tissue Tumor,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center of Cancer,Tianjin Key Laboratory of Cancer Prevention and Therapy,Tianjin’s Clinical Research Center for Cancer,Tianjin 300060,China;Basic Medical College,Tianjin Medical University,Tianjin 300070,China)

机构地区：[1]天津医科大学肿瘤医院肿瘤生物样本库,国家肿瘤临床医学研究中心,天津市“肿瘤防治”重点实验室,天津市恶性肿瘤临床医学研究中心,天津市300060 [2]天津医科大学肿瘤医院骨与软组织肿瘤科 [3]天津医科大学基础医学院

出　　处：《中国肿瘤临床》2021年第20期1047-1051,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:本研究旨在探索高剂量甲氨蝶呤(methotrexate,MTX)治疗骨肉瘤后导致白细胞降低的风险因素。方法:回顾性分析2017年1月至2019年12月天津医科大学肿瘤医院诊疗的骨肉瘤患者资料,并制定纳入排除标准。结果:经过筛选,43例骨肉瘤患者的177个周期的MTX化疗资料被纳入本研究。化疗前病理检测Ki-67>20%(OR=2.962,95%CI 1.416~5.092;P<0.004)、24 h C_(MTX)>1.0μmol/L(OR=9.600,95%CI 4.728~19.491;P<0.001)及轻度贫血(OR=2.157,95%CI 1.125~4.134;P=0.021)是化疗后出现白细胞降低的危险因素。结论:第24 h C_(MTX)、Ki-67和MTX治疗前血红蛋白水平是接受高剂量MTX治疗的骨肉瘤患者发生白细胞降低的风险因素。临床医护人员可在围化疗期间密切监测上述指标,以预判白细胞降低发生的可能性。Objective:To identify risk factors for leukopenia(LP)after high-dose methotrexate treatment for osteosarcoma.Methods:Retrospectively analyzed the data of patients with osteosarcoma diagnosed and treated in Tianjin Medical University Cancer Institute and Hospital from January 2017 to December 2019,and developed inclusion and exclusion criteria.Results:Based on the inclusion/exclusion criteria and the progress in both diagnostic modalities and therapeutic procedures,43 patients with osteosarcoma(177 cycles chemotherapy)were included in this study.The analysis showed that Ki-67 index(OR=2.962,95%CI 1.416-5.092,P<0.004),24-h C_(MTX)(OR=9.600,95%CI 4.728-19.491,P<0.001),and pre-chemotherapy anemia(OR=2.157,95%CI 1.125-4.134,P=0.021)were independent risk factors for leukopenia after high-dose methotrexate treatment.Conclusions:Ki-67 index,24-h C_(MTX),and pre-chemotherapy anemia were correlated with LP occurrence after methotrexate treatment in osteosarcoma.The factors can be potentially used for predicting and monitoring LP after high-dose methotrexate treatment for osteosarcoma.

关 键 词：骨肉瘤 甲氨蝶呤 白细胞降低 风险因素 

分 类 号：R738.1[医药卫生—肿瘤]