Meme Kanseri Hastalarında Tedavi Ilişkili Nötropeni Gelişimini Etkileyen Risk Faktörleri

Abstract

Aim: This study aims to investigate treatment and patient related risk factors that influence development of chemotherapy induced neutropenia (CIN). Material and Method: 679 female breast cancer patients who received anthracycline, taxane or CMF containing chemotherapy regimens between 2006-2013 in Hacettepe University Oncology Hospital were participated in this study. Patients who received granulocyte colony stimulating factor as primary prophylaxis were excluded. To exclude impact of using colony stimulating factors as secondary prophylaxis and alternation in chemotherapy doses, we took into account the chemotherapy cycle in which neutropenia developed first. Data about demographic characteristics ( age, body mass index (BMI), menopausal status, comorbidities, Charlson Comorbidty Index score), treatment modalities ( type of surgery, chemotherapy regimen, receiving radiotherapy or trastuzumab), pretreatment blood count parameters ( white blood cell count, absolute neutrophil count, lymphocyte count, neutrophil/lymphocyte ratio) of patients were collected retrospectively from medical records. The relationship between these variables and development/severity of chemotherapy induced neutropenia was examined. The difference between the groups were accepted as significant if p<0.05 in all analyzes. Results: In univariate analysis, CIN was found associated with lower BMI and lower baseline white blood cell count (p= 0,001 ve p< 0,001). Similar neutropenia rates was monitored between patients who have neutrophil/lymphocyte ratio ≥3 and <3 (p=0,448). In multivariate logistic regression analysis; older age (≥60), lower baseline white blood cell count and having 2 or more comorbidities were shown to increase risk of neutropenia ((p=0,014,p=0,048 and p=0,002). CIN development and severity did not differ between chemotherapy regimen groups. Being overweight or obese decrease risk of CIN (p=0,001 and p<0,001). Grade 3-4 CIN incidence was statistically higher in metastatic patients (p=0,007). Conclusion: We conclude that older age ( ≥60), lower baseline white blood cell count, lower body mass index and having 2 or more comorbidities are associated with increased risk of CIN.