“隐性肾损”对卡培他滨治疗晚期结直肠癌安全性和有效性的影响

Impact of Unrecognized Renal Insufficiency on the Safety and Efficacy of Capecitabine for Metastatic Colorectal Cancer Patients

关键词:  隐性肾损  卡培他滨  结直肠癌

Key words:  unrecognized renal insufficiency  capecitabine  colorectal cancer

摘要:

目的 考察“隐性肾损”(肿瘤患者血清肌酐值正常，但肌酐清除率明显下降的现象)对卡培他滨治疗晚期结直肠癌安全性和有效性的影响。方法 回顾性抽取2010年8月—2012年8月杭州市第一人民医院血清肌酐正常、以卡培他滨治疗的晚期结直肠癌患者资料，以Cockcroft-Gault公式计算肌酐清除率(CrCL)，分为“隐性肾损”组(CrCL≤60 mL·min^-1)和对照组(CrCL>60 mL·min^-1)，比较2组不良反应和疗效指标。结果 共143例患者纳入研究，34.9%患者发生“隐性肾损”。“隐性肾损”组较对照组1~2度骨髓抑制、腹泻、口腔炎和手足综合征发生较高，化疗反应率和疾病进展时间较小(P<0.05)，生存时间差异无统计学意义。结论 “隐性肾损”影响卡培他滨治疗晚期结直肠癌的安全性和有效性，临床上应以肌酐清除率对患者进行肾功能筛查及必要剂量调整。

Abstract:

OBJECTIVE To determine the impact of unrecognized renal insufficiency(URI) on safety and efficacy of chemotherapy in metastatic colorectal cancer (mCRC). METHODS Medical records of mCRC patients with normal SCr started on capecitabine plus oxaliplatin(XELOX) were retrospectively reviewed. CrCL was estimated using the Cockcroft-Gault formula. The patients were divided into URI group and control group, and the toxicities and effectiveness of therapy were compared between the two groups. RESULTS A total of 143 patients were enrolled, in which 34.9% experienced URI. The URI group developed significantly more grade 1-2 toxicities including myelosuppression, diarrhea, stomatitis and hand-foot syndrome. The response rate and TTP were significantly lower in URI group, whereas the OS was similar in two groups. CONCLUSION URI can increase the toxicity and decrease the survival of XELOX-treated mCRC patients. Renal function screening via CrCL estimation is required for all mCRC patients before initial chemotherapy.