Febrilna nevtropenija in nevtropenija višje stopnje ob adjuvantnem zdravljenju nedrobnoceličnega raka pljuč v vsakodnevni praksi

Based on clinical trial data, platinum-based adjuvant chemotherapy (Cht) is an intermediate risk factor for febrile neutropenia in patients with operable non-small-cell lung cancer (NSCLC). This study aims to assess the incidence of febrile neutropenia (FN) and high-grade neutropenia (G 3/4 N) in a group of patients treated in everyday clinical practice, and to determine the groups of patients that are at high risk of developing FN and G 3/4 N. Methods: This observational cohort study included 150 consecutive patient treatments with adjuvant Cht at the University Clinic Golnik, from January 2010 to May 2016. Complete blood counts ware taken on day 1 and day 8 of each cycle, and during each cycle of Cht if clinically indicated. Primary prophylaxis with G-CSF was used based on physician%s decision. The patients and treatment characteristics were collected from the hospital registry data. The average number of Cht cycles was 3.7 (range 1-4). To assess the risk factors, a logistic regression analysis was conducted. Results: Only 6/150 (4%) patients developed FN and 43/150 (29%) patients developed G 3/4 N. None of these patients received primary prophylaxis with G-CSF. Out of the nine risk factors assessed (age, gender, histologic type, stage, performance status, presence of comorbidities, type of surgery, Cht regimen, and year of treatment) only the year of treatment (before/after 2013) appeared to be a significant predictor of FN plus G 3/4 N incidence in the regression model. However, inspecting the frequency table indicates a tendency for higher incidence of FN in the subgroups of patients with pneumonectomy, higher PS, and in those receiving carboplatin. Conclusion: The incidence of FN and G 3/4 N during platinum- -based adjuvant Cht for NSCLC in our daily practice is comparable to the incidence reported in clinical studies. According to our observation, it seems that patients with pneumonectomy, higher performance status, and those receiving carboplatin are those who would benefit most from primary prophylaxis with G-CSF. The decline of FN and G 3/4 N incidence in the second treatment period (after the year 2013) is probably reflecting a more adequate usage of primary prophylaxis with G-CSF at our clinic.Dopolnilna kemoterapija (KT) na bazi platine je srednje močan dejavnik tveganja za pojav febrilne nevtropenije (10- do 20-odstotna incidenca) pri operabilnem raku pljuč. Namen raziskave je bil preveriti pojavnost febrilne nevtropenije (FN) in nevtropenije višje stopnje (N G 3/4) v vsakodnevni klinični praksi napram izsledkom v kliničnih raziskavah ter opredeliti skupine bolnikov, ki imajo višje tveganje za pojav FN in N G 3/4. Metoda: V našo prospektivno, observacijsko raziskavo je bilo vključenih 150 bolnikov s postavljeno diagnozo operabilnega nedrobnoceličnega raka pljuč v obdobju od januarja 2010 do maja 2016 na Kliniki Golnik. Podatke o bolnikih in o zdravljenju smo povzeli iz bolnišničnega registra raka pljuč. Bolniki so bili zdravljeni z dopolnilno KT na bazi platine po radikalni kirurški odstranitvi primarnega pljučnega tumorja. V povprečju so bolniki prejeli 3,7 od predvidenih štirih ciklusov KT. Krvna slika je bila analizirana 1. in 8. dan vsakega cikla KT ter, če je bilo indicirano, kadarkoli v času prejemanja KT. Po presoji zdravnika so bolniki prejeli primarno profilakso z rastnimi dejavniki za nevtrofilne granulocite (pG-CSF). Za analizo dejavnikov tveganja za pojav FN in N G 3/4 smo uporabili logistično regresijo. Rezultati: Febrilno nevtropenijo je utrpelo 4 % (N = 6) bolnikov in N G 3/4 29 % (N = 43) bolnikov, nobeden od njih ni prejel pG-CSF. Od devetih opazovanih dejavnikov tveganja (starost, spol, histološki tip, stadij, stanje zmogljivosti, prisotnost pridruženih obolenj, tip operacije, vrsta KT in obdobje zdravljenja) se je v regresijskem modelu le obdobje zdravljenja izkazalo za statistično pomemben napovednik pojava FN in N G 3/4. Opazili pa smo tudi trend k višji pojavnosti FN pri bolnikih po pulmektomiji, s slabšim stanjem zmogljivosti in pri prejemanju karboplatina v citostatski shemi. Zaključek: V klinični praksi je pojavnost FN in N G 3/4 ob dopolnilni KT operabilnega nedrobnoceličnega raka pljuč primerljiva pojavnosti v kliničnih raziskavah. Bolniki po pulmektomiji, bolniki s slabšim stanjem zmogljivosti in ob prejemanju karboplatina imajo verjetno večjo korist od pG-CSF. Upad pojavnosti FN in N G 3/4 v drugem opazovanem časovnem obdobju (leta 2013-2016) verjetno odraža ustreznejšo uporabo pG-CSF na naši kliniki v tem obdobju