国际肿瘤学杂志

国际肿瘤学杂志 ›› 2026, Vol. 53 ›› Issue (10): 608-614.doi: 10.3760/cma.j.cn371439-20260423-00096

• 论著 • 上一篇    下一篇

不同化疗方案对中老年卵巢癌患者重度及以上中性粒细胞减少症发生的影响

姜晔1,2, 季霜3, 劳家辉2, 闫莉4, 刘亚民2(), 唐芳2()   

  1. 1 山东大学护理与康复学院， 济南 250100
    2 山东第一医科大学第一附属医院（山东省千佛山医院）健康医疗大数据研究中心， 山东省数据开放创新应用实验室， 济南 250014
    3 临沂市妇幼保健院医保科， 临沂 276000
    4 山东第一医科大学第一附属医院（山东省千佛山医院）妇科， 济南 250014
  • 收稿日期:2026-04-23 出版日期:2026-10-08 发布日期:2026-10-10
  • 通讯作者: 唐芳，Email：tangfangsdu@126.com；
    刘亚民，Email：yaminl@126.com
  • 作者简介:

    姜晔、季霜：数据收集、整理、分析，论文撰写；劳家辉：数据分析、论文修改；闫莉、刘亚民：研究指导、论文修改；唐芳：研究设计、研究指导、论文修改

  • 基金资助:
    泰山学者青年专家项目(tsqn202408369)

Impact of different chemotherapy regimens on the occurrence of grade ≥ 3 neutropenia in middle-aged and elderly patients with ovarian cancer

Jiang Ye1,2, Ji Shuang3, Lao Jiahui2, Yan Li4, Liu Yamin2(), Tang Fang2()   

  1. 1 School of Nursing and Rehabilitation， Shandong University， Jinan 250100， China
    2 Center for Big Data Research in Health and Medicine， First Affiliated Hospital of Shandong First Medical University （Shandong Provincial Qianfoshan Hospital），Shandong Data Open Innovative Application Laboratory， Jinan 250014， China
    3 Department of Medical Insurance， Women & Children's Health Care Hospital of Linyi， Linyi 276000， China
    4 Department of Gynecology， First Affiliated Hospital of Shandong First Medical University （Shandong Provincial Qianfoshan Hospital）， Jinan 250014， China
  • Received:2026-04-23 Online:2026-10-08 Published:2026-10-10
  • Contact: Tang Fang，Email：tangfangsdu@126.com；
    Liu Yamin，Email：yaminl@126.com
  • Supported by:
    Taishan Scholars Program of Shandong Province-Young Taishan Scholars(tsqn202408369)

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摘要：

目的 分析不同化疗方案对中老年卵巢癌患者各化疗周期内重度及以上中性粒细胞减少症发生的影响。方法 选取2009年1月至2022年6月于山东省第一医科大学第一附属医院（山东省千佛山医院）接受化疗的492例中老年卵巢癌患者为研究对象， 建立纵向队列。根据每个化疗周期是否发生重度及以上中性粒细胞减少症， 将全部化疗周期划分为发生组（215个周期）和未发生组（1 803个周期）。比较两组化疗周期内的临床资料、化疗前实验室检查指标、合并症、复发后化疗情况、化疗方案及具体药物。采用广义估计方程（GEE）分析不同化疗方案及药物对重度及以上中性粒细胞减少症发生的影响， 并在模型中调整化疗前实验室指标、合并症、复发化疗、年份及化疗周期数等混杂因素。结果 重度及以上中性粒细胞减少症发生组与未发生组在化疗前白细胞计数、红细胞计数、血小板计数、中性粒细胞绝对计数、单核细胞计数、淋巴细胞计数、嗜酸性粒细胞计数、血红蛋白、血清总胆红素、谷草转氨酶、是否复发后化疗、铂类用药、紫杉醇类用药方面的差异均有统计学意义（均P<0.05）。单因素GEE结果显示， 铂类联合环磷酰胺化疗方案（OR=0.273， 95%CI为0.080~0.936， P=0.039）、多西他赛（OR=0.612， 95%CI为0.390~0.960， P=0.033）与重度及以上中性粒细胞减少症发生风险呈负相关；白蛋白结合型紫杉醇（OR=1.778， 95%CI为1.053~3.000， P=0.031）与重度及以上中性粒细胞减少症发生风险呈正相关。在控制潜在混杂因素基础上构建的多因素GEE分析结果显示， 铂类联合环磷酰胺化疗方案（OR=0.151， 95%CI为0.149~0.154， P<0.001）、溶剂型紫杉醇（OR=0.383， 95%CI为0.348~0.421， P<0.001）、多西他赛（OR=0.644， 95%CI为0.431~0.960， P=0.031）是重度及以上中性粒细胞减少症的保护因素；使用卡铂（OR=1.771， 95%CI为1.374~2.282， P<0.001）、白蛋白结合型紫杉醇（OR=1.937， 95%CI为1.216~3.087， P=0.005）是重度及以上中性粒细胞减少症的危险因素。结论 不同化疗方案对中老年卵巢癌化疗周期内重度及以上中性粒细胞减少症的发生影响不同。铂类联合环磷酰胺、溶剂型紫杉醇和多西他赛或可降低该不良反应的发生风险， 采用卡铂、白蛋白结合型紫杉醇化疗方案时， 应密切监测上述不良反应。

关键词: 卵巢肿瘤, 药物疗法, 中性粒细胞减少

Abstract:

Objective To analyze the impact of different chemotherapy regimens on the occurrence of grade ≥ 3 neutropenia within chemotherapy cycles in middle-aged and elderly patients with ovarian cancer. Methods A longitudinal cohort was established comprising 492 middle-aged and elderly patients with ovarian cancer who received chemotherapy at the First Affiliated Hospital of Shandong First Medical University （Shandong Provincial Qianfoshan Hospital） between January 2009 and June 2022. All chemotherapy cycles were categorized into a group with grade ≥ 3 neutropenia （215 cycles） and a group without grade ≥ 3 neutropenia （1 803 cycles）， according to whether grade ≥ 3 neutropenia occurred in each cycle. The two groups were compared with respect to clinical data within the chemotherapy cycles， pre-chemotherapy laboratory parameters， comorbidities， status of chemotherapy after relapse， chemotherapy regimens， and specific drugs. A generalized estimating equation （GEE） was employed to analyze the impact of different chemotherapy regimens and drugs on the occurrence of grade ≥ 3 neutropenia. And the confounding factors such as pre-chemotherapy laboratory parameters， comorbidities， chemotherapy after relapse， year， and number of chemotherapy cycles were adjusted in the model. Results There were statistically significant differences between the group with grade ≥ 3 neutropenia and the group without grade ≥ 3 neutropenia in pre-chemotherapy white blood cells， red blood cells， platelets， absolute neutropenia count， monocytes， lymphocytes， eosinophils， hemoglobin， serum total bilirubin， aspartate aminotransferase， chemotherapy after relapse， platinum， and paclitaxel （all P<0.05）. Univariate GEE results showed that platinum plus cyclophosphamide regimen （OR=0.273， 95%CI：0.080-0.936， P=0.039） and docetaxel （OR=0.612， 95%CI：0.390-0.960， P=0.033） were negatively associated with the risk of grade ≥ 3 neutropenia， whereas albumin-bound paclitaxel （OR=1.778， 95%CI：1.053-3.000， P=0.031） was positively associated with the risk of grade ≥ 3 neutropenia. Multivariate GEE analysis after adjusting for potential confounding factors revealed that the platinum plus cyclophosphamide regimen （OR=0.151， 95%CI：0.149-0.154， P<0.001）， solvent-based paclitaxel （OR=0.383， 95%CI：0.348-0.421， P<0.001）， and docetaxel （OR=0.644， 95%CI：0.431-0.960， P=0.031） were protective factors against grade ≥ 3 neutropenia， whereas carboplatin （OR=1.771， 95%CI：1.374-2.282， P<0.001） and albumin-bound paclitaxel （OR=1.937， 95%CI：1.216-3.087， P=0.005） were risk factors for grade ≥ 3 neutropenia. Conclusions Among middle-aged and elderly patients with ovarian cancer， the risk of grade ≥ 3 neutropenia during chemotherapy cycles varies across different chemotherapy regimens. Platinum plus cyclophosphamide， solvent-based paclitaxel， and docetaxel may reduce the risk of this adverse reaction， whereas close monitoring for the above-mentioned adverse reaction is recommended when using regimens such as carboplatin or albumin-bound paclitaxel.

Key words: Ovarian neoplasms, Drug therapy, Neutropenia