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