胃癌同期放化疗所致血小板减少危险因素分析

doi:10.3760/cma.j.cn113030-20210802-00283

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摘要目的分析胃癌患者同期放化疗期间发生>2级血小板减少[TPG2(+)]的相关危险因素。方法回顾性分析2018—2020年间在中山大学肿瘤防治中心接受同期放化疗的非转移性胃腺癌患者治疗前临床资料、血液学参数及相关椎体剂量学参数与TPG2(+)的相关性。结果共纳入58例患者,其中TPG2(+)组23例(40%),TPG2(-)组35例(60%),两组间在临床基本资料上具有可比性(均P>0.05)。Logistic回归模型单因素分析显示放疗前外周血血小板计数(PLT)、嗜碱性粒细胞计数(BA)、乳酸脱氢酶(LDH)以及CTV最长径(LCTV)、勾画椎体个数(VBN)、VBN校正的椎体总体积(VBV)、Dmax、Dmean、V5Gy、V10Gy、V20Gy、V30Gy、V40Gy,与TPG2(+)相关(均P<0.05),多因素分析显示放疗前PLT减少、LDH升高、LCTV较长、V20Gy/VBN较高(P=0.048、0.028、0.013、0.030)可能增加TPG2(+)的发生风险。结论对于胃腺癌的同期放化疗,治疗前纠正PLT减少、避免较长的CTV以及控制VBN校正的V20Gy有可能减少放化疗导致的显著血小板降低。

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	张莉
	张玉晶
	王继金
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	蔡晓军
	宋盈

关键词 ：胃肿瘤/同期放化疗法, 血小板减少, 因素分析

Abstract：Objective To investigate the related risk factors of thrombocytopenia grade 2+[TPG2(+)] in patients with gastric cancer during chemoradiotherapy. Methods The pre-treatmentclinical data, hematologic parameters, and the correlation between dose distribution of vertebrae andTPG2(+) in non-metastaticgastric adenocarcinoma patients receiving concurrent chemoradiation in Sun Yat-sen University Cancer Center were retrospectively analyzed. Results A total of 58 patients were included, including 23 cases (40%) in theTPG2(+) group and 35(60%) in the TPG2(-) group. There was no statistical difference in baseline clinical data between two groups (all P>0.05). Univariate Logistic regression analysis showed that several baseline parameters including platelet count (PLT),basophil count (BA),lactate dehydrogenase (LDH) and length of CTV (LCTV),the number of vertebrae (VBN), vertebral body volume (VBV), Dmax, Dmean,V5Gy,V10Gy,V20Gy,V30Gy and V40Gywere correlated with TPG2(+)(all P<0.05). However, the multivariate Logistic regressionanalysisshowed that low PLT (P=0.048),high LDH (P=0.028),increased LCTV (P=0.013),high V20Gy/VBN (P=0.030) were associated with the risk of TPG2(+). Conclusion In gastric adenocarcinoma patients treated with chemoradiotherapy,correction of PLT reduction before treatment,avoidinglonger CTV and controlled V20Gy correction for vertebral number may reduce significant thrombocytopenia induced by chemoradiotherapy.

Key words： Gastric neoplasm/chemoradiotherapy Thrombopenia Factor analysis

收稿日期: 2021-08-02

通讯作者: 张玉晶,Email:zhangyj@sysucc.org.cn

引用本文:

张莉,张玉晶,王继金等. 胃癌同期放化疗所致血小板减少危险因素分析[J]. 中华放射肿瘤学杂志, 2022, 31(2): 160-164.

Zhang Li,Zhang Yujing,Wang Jijin et al. Analysis of risk factors of thrombocytopenia toxicityduring concurrent chemoradiation of gastric cancer[J]. Chinese Journal of Radiation Oncology, 2022, 31(2): 160-164.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.cn113030-20210802-00283 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2022/V31/I2/160

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