Abstract：
OBJECTIVE: Irinotecan sometimes causes lethal septic shock but the risk factors remain unclear. This retrospective case-control study explored the potential risk factors for septic shock following irinotecan treatment.
METHODS: All women who received irinotecan-containing chemotherapy for gynecologic malignancies at Shizuoka General Hospital from October 2014 to September 2020 were investigated. The clinical backgrounds and blood test results of those who developed septic shock after irinotecan-containing chemotherapy were compared with those who did not. Odds ratios (ORs) for developing septic shock after receiving irinotecan were calculated with 95% confidence intervals (CIs), using univariable logistic regression analysis.
RESULTS: During the study period, 147 women received irinotecan-containing chemotherapy. Three women developed septic shock due to neutropenic enterocolitis after irinotecan treatment, and 144 did not. The three patients with septic shock had recurrent cervical cancer, heterozygous variants in the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene (two patients had *1/*6, one had *1/*28 variants), a history of concurrent chemoradiation therapy, 50-60 Gy of pelvic irradiation, and platinum-combined chemotherapy. A history of pelvic irradiation was identified as a possible risk factor for developing septic shock after irinotecan-containing chemotherapy (OR 63.0, 95% CI 5.71-8635; p < 0.001). The OR of UGT1A1 polymorphism for septic shock was 9.09 (95% CI 0.86-1233; p = 0.070) in the complete case analysis.
CONCLUSIONS: Medical personnel involved in cancer therapy should consider the possible risk of septic shock developing due to neutropenic enterocolitis when administering irinotecan-containing chemotherapy in patients with a history of pelvic irradiation.
METHODS: All women who received irinotecan-containing chemotherapy for gynecologic malignancies at Shizuoka General Hospital from October 2014 to September 2020 were investigated. The clinical backgrounds and blood test results of those who developed septic shock after irinotecan-containing chemotherapy were compared with those who did not. Odds ratios (ORs) for developing septic shock after receiving irinotecan were calculated with 95% confidence intervals (CIs), using univariable logistic regression analysis.
RESULTS: During the study period, 147 women received irinotecan-containing chemotherapy. Three women developed septic shock due to neutropenic enterocolitis after irinotecan treatment, and 144 did not. The three patients with septic shock had recurrent cervical cancer, heterozygous variants in the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) gene (two patients had *1/*6, one had *1/*28 variants), a history of concurrent chemoradiation therapy, 50-60 Gy of pelvic irradiation, and platinum-combined chemotherapy. A history of pelvic irradiation was identified as a possible risk factor for developing septic shock after irinotecan-containing chemotherapy (OR 63.0, 95% CI 5.71-8635; p < 0.001). The OR of UGT1A1 polymorphism for septic shock was 9.09 (95% CI 0.86-1233; p = 0.070) in the complete case analysis.
CONCLUSIONS: Medical personnel involved in cancer therapy should consider the possible risk of septic shock developing due to neutropenic enterocolitis when administering irinotecan-containing chemotherapy in patients with a history of pelvic irradiation.
摘要：
目的：伊立替康有时会引起致死性感染性休克，但其危险因素尚不清楚。这项回顾性病例对照研究探讨了伊立替康治疗后感染性休克的潜在危险因素。
方法：对2014年10月至2020年9月在静冈总医院接受含伊立替康的妇科恶性肿瘤化疗的所有女性进行调查。将含有伊立替康的化疗后发生感染性休克的患者的临床背景和血液检查结果与未发生感染性休克的患者进行比较。使用95％置信区间（CI）计算接受伊立替康后发生感染性休克的几率（OR），采用单变量Logistic回归分析。
结果：在研究期间，147名妇女接受了含伊立替康的化疗。伊立替康治疗后，三名妇女因中性粒细胞减少性小肠结肠炎而出现感染性休克，144没有。3例脓毒性休克患者有复发性宫颈癌,尿苷二磷酸葡萄糖醛酸基转移酶1A1（UGT1A1）基因中的杂合变体（两名患者有*1/*6，一名患者有*1/*28变体），同步放化疗史,50-60Gy的骨盆照射，和铂类联合化疗。盆腔照射史被确定为含伊立替康的化疗后发生感染性休克的可能危险因素(OR63.0,95%CI5.71-8635;p<0.001)。在完整病例分析中，UGT1A1多态性对感染性休克的OR为9.09（95％CI0.86-1233；p=0.070）。
结论：参与癌症治疗的医务人员在对有盆腔放疗史的患者进行含伊立替康的化疗时，应考虑中性粒细胞减少性小肠结肠炎引起感染性休克的可能风险。
方法：对2014年10月至2020年9月在静冈总医院接受含伊立替康的妇科恶性肿瘤化疗的所有女性进行调查。将含有伊立替康的化疗后发生感染性休克的患者的临床背景和血液检查结果与未发生感染性休克的患者进行比较。使用95％置信区间（CI）计算接受伊立替康后发生感染性休克的几率（OR），采用单变量Logistic回归分析。
结果：在研究期间，147名妇女接受了含伊立替康的化疗。伊立替康治疗后，三名妇女因中性粒细胞减少性小肠结肠炎而出现感染性休克，144没有。3例脓毒性休克患者有复发性宫颈癌,尿苷二磷酸葡萄糖醛酸基转移酶1A1（UGT1A1）基因中的杂合变体（两名患者有*1/*6，一名患者有*1/*28变体），同步放化疗史,50-60Gy的骨盆照射，和铂类联合化疗。盆腔照射史被确定为含伊立替康的化疗后发生感染性休克的可能危险因素(OR63.0,95%CI5.71-8635;p<0.001)。在完整病例分析中，UGT1A1多态性对感染性休克的OR为9.09（95％CI0.86-1233；p=0.070）。
结论：参与癌症治疗的医务人员在对有盆腔放疗史的患者进行含伊立替康的化疗时，应考虑中性粒细胞减少性小肠结肠炎引起感染性休克的可能风险。
