中国广泛期小细胞肺癌（ES-SCLC）患者化疗诱导骨髓抑制（CIM）负担：一项回顾性现实世界研究

Chinese medical journal pulmonary and critical care medicine Pub Date : 2025-09-01 DOI:10.1016/j.pccm.2025.08.004

Kailun Fei , Wenjing Yang , Jianchun Duan , Jiachen Xu , Jie Zhao , Jie Wang , Zhijie Wang

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Patients receiving immune checkpoint inhibitors (ICIs) plus EP (<em>n</em>=1674) had a significantly higher incidence of at least one CIM during the ICI combination therapy (87.8 % [1469/1674] <em>vs.</em> 82.8 % [4827/5831]; <em>χ²</em>=23.43, <em>P</em><0.0001) and grade 3–4 CIM (25.7 % [430/1674] <em>vs.</em> 20.6 % [1201/5831]; <em>χ²</em>=19.51, <em>P</em><0.0001) compared to those receiving other EP-based therapies during EP chemotherapy (<em>n</em>=5831). Rates of use of granulocyte colony-stimulating factor, thrombopoietin, interleukin-11, erythropoiesis-stimulating agents, and blood transfusion were 81.1 % (<em>n</em>=6087), 9.2 % (<em>n</em>=691), 12.4 % (<em>n</em>=927), 9.0 % (<em>n</em>=678), and 12.1 % (<em>n</em>=907), respectively. 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引用次数: 0

摘要

背景：在中国广泛期小细胞肺癌（ES-SCLC）患者中，与化疗诱导骨髓抑制（CIM）相关的疾病负担、治疗模式和经济成本仍然缺乏特征，特别是在来自大量人群的现实世界证据方面。本研究旨在描述中国ES-SCLC并发CIM的发病率、治疗模式、成本和医疗资源利用（HCRU）。方法回顾性分析2018年1月1日至2022年12月31日期间首次开始依托泊肽-铂（EP）化疗的ES-SCLC成人患者，并从中国国家癌症信息数据库中检索。收集基线人口统计学和临床数据。评估了EP化疗期间和随访期间的cim相关事件、治疗、费用和HCRU信息。采用Kruskal-Wallis试验比较3-4级CIM、1-2级CIM和非CIM患者的成本和HCRU。结果共纳入ES-SCLC患者7505例，平均年龄61.2岁，女性17.7 %[1332/7505]，体重指数23.2±3.3 kg/m2。在开始以ep为基础的化疗后，6901例患者（92.0 %）经历了至少一次cim相关事件。1883例患者（25.1% %）中至少发生了一次3-4级CIM事件，包括单系（中性粒细胞减少[n=609, 8.1 %]，血小板减少[n=85, 1.1 %]，贫血[n=797, 10.6 %]），双系（n=318, 4.2 %）和三系（n=74, 1.0 %）事件。接受免疫检查点抑制剂(ICIs) + EP （n=1674）的患者在ICI联合治疗期间至少有一种CIM的发生率（87.8 % [1469/1674]vs. 82.8 % [4827/5831];χ²=23.43,P<0.0001）和3-4级CIM（25.7 % [430/1674]vs. 20.6 % [1201/5831];χ²=19.51,P<0.0001）显著高于在EP化疗期间接受其他基于EP的治疗的患者（n=5831）。粒细胞集落刺激因子、血小板生成素、白细胞介素-11、促红细胞生成素和输血的使用率分别为81.1 % （n=6087）、9.2 % （n=691）、12.4 % （n=927）、9.0% （n=678）和12.1% （n=907）。3-4级CIM患者的HCRU和每位患者的总成本高于没有CIM或1-2级CIM的患者，并且各组之间的总成本存在显著差异（H=195.54, P <0.0001）。结论：尽管中国ES-SCLC患者可获得CIM支持治疗，但仍存在相当大的临床和经济负担。保护骨髓不发展为高级别骨髓抑制的策略可以减轻患者和医疗机构的负担。

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Burden of chemotherapy-induced myelosuppression (CIM) in Chinese patients with extensive-stage small cell lung cancer (ES-SCLC): A retrospective real-world study

Background

The disease burden, treatment patterns, and financial costs associated with chemotherapy-induced myelosuppression (CIM) in Chinese patients with extensive-stage small cell lung cancer (ES-SCLC) remain poorly characterized, particularly in terms of real-world evidence derived from large populations. This study aimed to describe the incidence, treatment patterns, costs, and healthcare resource utilization (HCRU) in Chinese patients with ES-SCLC who develop CIM.

Methods

Adults diagnosed with ES-SCLC who started etoposide–platinum (EP) chemotherapy for the first time between January 1, 2018 and December 31, 2022 were retrospectively identified in the Chinese National Cancer Information Database. Baseline demographic and clinical data were collected. Information on CIM-related events, treatment, costs, and HCRU during EP chemotherapy and during follow-up was assessed. Costs and HCRU were compared among patients with grade 3–4 CIM, grade 1–2 CIM, and no CIM using the Kruskal–Wallis test.

Results

In total, 7505 patients with ES-SCLC (mean age 61.2 years; 17.7 % [1332/7505] female; body mass index 23.2±3.3 kg/m²) were enrolled. After initiation of EP-based chemotherapy, 6901 patients (92.0 %) experienced at least one CIM-related event. At least one grade 3–4 CIM event occurred in 1883 patients (25.1 %) and consisted of single-lineage (neutropenia [n=609, 8.1 %], thrombocytopenia [n=85, 1.1 %], anemia [n=797, 10.6 %]), two-lineage (n=318, 4.2 %), and three-lineage (n=74, 1.0 %) events. Patients receiving immune checkpoint inhibitors (ICIs) plus EP (n=1674) had a significantly higher incidence of at least one CIM during the ICI combination therapy (87.8 % [1469/1674] vs. 82.8 % [4827/5831]; χ²=23.43, P<0.0001) and grade 3–4 CIM (25.7 % [430/1674] vs. 20.6 % [1201/5831]; χ²=19.51, P<0.0001) compared to those receiving other EP-based therapies during EP chemotherapy (n=5831). Rates of use of granulocyte colony-stimulating factor, thrombopoietin, interleukin-11, erythropoiesis-stimulating agents, and blood transfusion were 81.1 % (n=6087), 9.2 % (n=691), 12.4 % (n=927), 9.0 % (n=678), and 12.1 % (n=907), respectively. HCRU and total costs per patient were higher for those with grade 3–4 CIM than for those without CIM or grade 1–2 CIM, and significant differences in the total cost were observed across groups (H=195.54, P <0.0001).

Conclusion

Despite the availability of supportive care for CIM in patients with ES-SCLC in China, a considerable clinical and financial burden persists. Strategies that protect bone marrow from progressing to high-grade myelosuppression could reduce the burden on patients and healthcare organizations.

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来源期刊

Chinese medical journal pulmonary and critical care medicine Critical Care and Intensive Care Medicine, Infectious Diseases, Pulmonary and Respiratory Medicine

CiteScore

0.40

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0.00%

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