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

夏文彬; 吴海啸; 胡阳; 张瑾; 张超

doi:10.12354/j.issn.1000-8179.2021.20210743

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

摘要

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>1.0 μmol/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。

Abstract:
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.

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