背景:发热性中性粒细胞减少症是一种危重的肿瘤急症,它的管理在癌症治疗中至关重要。在几个准则中,除高危病例外,不推荐在化疗引起的发热性中性粒细胞减少症患者中使用粒细胞集落刺激因子(G-CSF).日本临床肿瘤学会更新了其使用G-CSF的临床实践指南,纳入系统评价来解决这个临床问题。
方法:系统综述是通过在PubMed,Cochrane图书馆,和Ichushi-Web,专注于1990年1月至2019年12月的出版物。选定的研究包括随机对照试验(RCTs),非RCT,以及队列和病例对照研究。评估结果包括总生存期,感染相关死亡率,住院时间,生活质量,和痛苦。
结果:最初的搜索产生了332条记录。经过两轮筛选,我们选择了两条记录进行定性和定量综合,包括荟萃分析.关于感染相关死亡率,G-CSF组为5:134(3.73%),非G-CSF组为6:129(4.65%),导致相对风险为0.83(95%置信区间,0.27-2.58;p=0.54),这没有统计学意义。仅住院时间的中位数可从两个随机对照试验中获得,排除荟萃分析。对于总体生存率,生活质量,和痛苦,没有找到合适的分析研究,使他们的评估不可行。
结论:在癌症化疗期间不对发热性中性粒细胞减少症患者给予G-CSF治疗的建议较弱。G-CSF治疗可考虑用于高危患者。
BACKGROUND: Febrile neutropenia represents a critical oncologic emergency, and its management is pivotal in cancer therapy. In several
guidelines, the use of granulocyte colony-stimulating factor (G-CSF) in patients with chemotherapy-induced febrile neutropenia is not routinely recommended except in high-risk cases. The Japan Society of Clinical Oncology has updated its clinical practice
guidelines for the use of G-CSF, incorporating a systematic review to address this clinical question.
METHODS: The systematic review was conducted by performing a comprehensive literature search across PubMed, the Cochrane Library, and Ichushi-Web, focusing on publications from January 1990 to December 2019. Selected studies included randomized controlled trials (RCTs), non-RCTs, and cohort and case-control studies. Evaluated outcomes included overall survival, infection-related mortality, hospitalization duration, quality of life, and pain.
RESULTS: The initial search yielded 332 records. Following two rounds of screening, two records were selected for both qualitative and quantitative synthesis including meta-analysis. Regarding infection-related mortality, the event to case ratio was 5:134 (3.73%) in the G-CSF group versus 6:129 (4.65%) in the non-G-CSF group, resulting in a relative risk of 0.83 (95% confidence interval, 0.27-2.58; p = 0.54), which was not statistically significant. Only median values for hospitalization duration were available from the two RCTs, precluding a meta-analysis. For overall survival, quality of life, and pain, no suitable studies were found for analysis, rendering their assessment unfeasible.
CONCLUSIONS: A weak recommendation is made that G-CSF treatment not be administered to patients with febrile neutropenia during cancer chemotherapy. G-CSF treatment can be considered for patients at high risk.