上海市癌症患者化疗所致恶心呕吐的横断面研究

doi:10.19401/j.cnki.1007-3639.2023.11.006

中国癌症杂志 ›› 2023, Vol. 33 ›› Issue (11): 1009-1017.doi: 10.19401/j.cnki.1007-3639.2023.11.006

上海市癌症患者化疗所致恶心呕吐的横断面研究

曾铖¹^,²(), 金奕滋¹^,², 李婷¹, 章真³, 梁晓华⁴, 唐曦⁵, 刘天舒⁶, 李琦⁷, 沈赞⁸, 姜斌⁹, 王理伟¹⁰, 张俊¹¹, 陈思宇¹², 周彩存¹³, 高勇¹⁴, 臧远胜¹⁵, 李恒宇¹⁶, 董宇超¹⁷, 湛先保¹⁸, 钟薏¹⁹, 刘苓霜²⁰, 秦悦农²¹, 胡夕春¹, 张剑¹^,²()

1.复旦大学附属肿瘤医院肿瘤大内科，复旦大学上海医学院肿瘤学系，上海 200032
2.复旦大学附属肿瘤医院Ⅰ期临床试验病房，复旦大学上海医学院肿瘤学系，上海 200032
3.复旦大学附属肿瘤医院放射治疗中心，复旦大学上海医学院肿瘤学系，上海市放射肿瘤学重点实验室，上海市放射治疗临床医学研究中心，上海 200032
4.复旦大学附属华山医院肿瘤科，上海 200040
5.复旦大学附属华东医院肿瘤科，上海 200040
6.复旦大学附属中山医院肿瘤内科，上海 200032
7.上海交通大学医学院附属第一人民医院肿瘤科，上海 200080
8.上海交通大学医学院附属第六人民医院肿瘤内科，上海 200233
9.上海交通大学医学院附属第九人民医院肿瘤科，上海 201999
10.上海交通大学医学院附属仁济医院肿瘤科，上海 200127
11.上海交通大学医学院附属瑞金医院肿瘤科，上海 200025
12.上海交通大学医学院附属新华医院肿瘤科，上海 200092
13.同济大学附属上海市肺科医院肿瘤科，上海 200433
14.同济大学附属东方医院肿瘤科，上海 200120
15.海军军医大学第二附属医院肿瘤科，上海 200070
16.海军军医大学第一附属医院甲乳外科，上海200433
17.海军军医大学第一附属医院呼吸与危重症医学科，上海200433
18.海军军医大学第一附属医院肿瘤科，上海200433
19.上海中医药大学附属上海市中西医结合医院肿瘤科，上海 200082
20.上海中医药大学附属龙华医院肿瘤科，上海 200032
21.上海中医药大学附属龙华医院中西医结合乳腺科，上海 200032

收稿日期:2023-05-02 修回日期:2023-09-10 出版日期:2023-11-30 发布日期:2023-12-14
通信作者: 张剑（ORCID: 0000-0002-7890-4187），主任医师，复旦大学附属肿瘤医院Ⅰ期临床试验病房副主任。
作者简介:曾铖（ORCID: 0009-0005-5307-3822），硕士在读。

Chemotherapy-induced nausea and vomiting among cancer patients in Shanghai: a cross-sectional study

ZENG Cheng¹^,²(), JIN Yizi¹^,², LI Ting¹, ZHANG Zhen³, LIANG Xiaohua⁴, TANG Xi⁵, LIU Tianshu⁶, LI Qi⁷, SHEN Zan⁸, JIANG Bin⁹, WANG Liwei¹⁰, ZHANG Jun¹¹, CHEN Siyu¹², ZHOU Caicun¹³, GAO Yong¹⁴, ZANG Yuansheng¹⁵, LI Hengyu¹⁶, DONG Yuchao¹⁷, ZHAN Xianbao¹⁸, ZHONG Yi¹⁹, LIU Lingshuang²⁰, QIN Yuenong²¹, HU Xichun¹, ZHANG Jian¹^,²()

1. Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
2. Phase Ⅰ Clinical Trial Center, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
3. Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai Key Laboratory of Radiation Oncology, Shanghai Clinical Research Center for Radiation Oncology, Shanghai 200032, China
4. Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
5. Department of Oncology, Huadong Hospital, Fudan University, Shanghai 200040, China
6. Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
7. Department of Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
8. Department of Oncology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
9. Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China
10. Department of Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
11. Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
12. Department of Oncology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
13. Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
14. Department of Oncology, Shanghai East Hospital, School of Medicine of Tongji University, Shanghai 200120, China
15. Department of Medical Oncology, The Second Affiliated Hospital of Naval Medical University, Shanghai 200070, China
16. Department of Throat and Breast, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
17. Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
18. Department of Oncology, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
19. Department of Oncology, Shanghai TCM-integrated Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200082, China
20. Department of Oncology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
21. Breast Department of Integrated Traditional Chinese and Western Medicine, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China

Received:2023-05-02 Revised:2023-09-10 Published:2023-11-30 Online:2023-12-14

摘要/Abstract

摘要：

背景与目的：化疗所致恶心呕吐（chemotherapy-induced nausea and vomiting，CINV）可使癌症患者机体功能紊乱，甚至导致死亡。预防CINV对于接受致吐性化疗方案的患者至关重要。本研究旨在分析上海市三甲医院CINV的发生情况及处理方式，探讨与CINV相关的危险因素，以期进一步改善CINV管理。方法：选取2022年10月—2022年12月在上海市16家三甲医院接受治疗的376例癌症患者作为研究对象，采用问卷调查的方式开展横断面研究。使用单因素和多因素logistic回归模型分析CINV的影响因素。 结果：2022年上海市CINV管理与指南符合率较5年前有显著改善。对于接受高致吐风险化疗方案的患者，指南符合率从21.6%提升至67.0%。对于接受中致吐风险化疗方案的患者，神经激肽-1（neurokinin-1，NK-1）受体抑制剂的使用并不能显著降低CINV的发生率。多因素分析显示，化疗方案是CINV发生的唯一独立危险因素（P<0.05）。 结论：化疗方案是影响CINV发生的独立危险因素，临床实践中应优先关注药物本身的致吐风险，做好风险评估，严格遵循指南，从而最大化地控制CINV。

关键词: 化疗所致恶心呕吐, 癌症, 横断面研究

Abstract:

Background and purpose: Chemotherapy-induced nausea and vomiting (CINV) can cause severe damage to body functions and even lead to death. The prevention of CINV is critically important in patients receiving emetogenic chemotherapy regimen. This study aimed to investigate the prevalence and treatment of CINV in Grade-A tertiary hospitals in Shanghai and explore risk factors of CINV to improve its management. Methods: The clinical data of 376 cancer patients in Grade-A tertiary hospitals in Shanghai from October 2022 to December 2022 were collected retrospectively. The questionnaire was used to conduct a cross-sectional study. The univariate and multivariable logistic regression models were used to evaluate the influencing factors of CINV. Results: The management and coincidence of the guideline in 2022 significantly improved compared to five years ago. For patients receiving high-emetic-risk chemotherapy regimen, the coincidence of the guideline increased from 21.6% to 67.0%. For patients receiving moderate-emetic-risk chemotherapy regimen, the neurokinin-1 (NK-1) receptor antagonist was not significantly associated with CINV. Multivariable analysis showed that the chemotherapy regimen was the only risk factor for CINV during the whole period (P<0.05). Conclusion: The chemotherapy regimen is the main risk factor for CINV. To control CINV better, clinical practitioners should focus on the intrinsic risk of chemotherapy regimens preferentially, estimate the risk and adhere better to guidelines.

Key words: Chemotherapy-induced nausea and vomiting, Cancer, Cross-sectional study

中图分类号:

R730.6

曾铖, 金奕滋, 李婷, 章真, 梁晓华, 唐曦, 刘天舒, 李琦, 沈赞, 姜斌, 王理伟, 张俊, 陈思宇, 周彩存, 高勇, 臧远胜, 李恒宇, 董宇超, 湛先保, 钟薏, 刘苓霜, 秦悦农, 胡夕春, 张剑. 上海市癌症患者化疗所致恶心呕吐的横断面研究[J]. 中国癌症杂志, 2023, 33(11): 1009-1017.

ZENG Cheng, JIN Yizi, LI Ting, ZHANG Zhen, LIANG Xiaohua, TANG Xi, LIU Tianshu, LI Qi, SHEN Zan, JIANG Bin, WANG Liwei, ZHANG Jun, CHEN Siyu, ZHOU Caicun, GAO Yong, ZANG Yuansheng, LI Hengyu, DONG Yuchao, ZHAN Xianbao, ZHONG Yi, LIU Lingshuang, QIN Yuenong, HU Xichun, ZHANG Jian. Chemotherapy-induced nausea and vomiting among cancer patients in Shanghai: a cross-sectional study[J]. China Oncology, 2023, 33(11): 1009-1017.

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参考文献 17

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Characteristic	Number of patients
Gender
Female	220 (58.5)
Male	156 (41.5)
Age/year
≤60	217 (57.7)
>60	159 (42.3)
Cancer type
Lung cancer	126 (33.5)
Breast cancer	103 (27.4)
Gastric cancer	113 (30.1)
Gynecologic cancer	34 (9.0)
Cycle of chemotherapy
The first	95 (25.3)
The second	85 (22.6)
The third and above	196 (52.1)
Chemotherapy regimen
Low/minimal emetic risk chemotherapy	25 (6.6)
MEC	109 (29.0)
HEC	242 (64.4)
Cisplatin-based	89 (23.7)
Carboplatin-based	64 (17.0)
AC-based	56 (14.9)
Others	33 (8.8)
Antiemetic regimen
Quadruple regimen	34 (9.0)
Triple regimen	152 (40.4)
NK-1 RA-based	135 (35.9)
Olanzapine-based	17 (4.5)
Dual regimen	133 (35.4)
Single regimen	40 (10.6)
None	17 (4.5)

Chemotherapy regimen	Incidence of CINV					Coincidence of guideline^*
Chemotherapy regimen	Quadruple regimen	Triple regimen	Dual regimen	Single regimen	None	Coincidence of guideline^*
MEC		15/27 (55.6)	23/51 (45.1)	17/29 (58.6)	2/2 (100.0)	78/109 (71.6)
HEC	27/33 (81.8)	69/124 (55.6)	46/75 (61.3)	4/6 (66.7)	2/4 (50.0)	157/242 (64.9)
Cisplatin-based	15/18 (83.3)	25/47 (53.2)	7/19 (36.8)	3/4 (75)	1/1 (100.0)	65/89 (73.0)
Carboplatin-based	4/6 (66.7)	16/36 (44.4)	10/19 (52.6)	0/1 (0.0)	0/2 (0.0)	42/64 (65.6)
AC-based	1/2 (50)	17/22 (77.3)	23/30 (76.7)	1/1 (100.0)	1/1 (100.0)	24/56 (42.9)
Others	7/7 (100)	11/19 (57.9)	6/7 (85.7)			26/33 (78.8)

Characteristic	Univariate analysis		Multivariable analysis
Characteristic	OR (95% CI)	P value	OR (95% CI)	P value
Gender
Female	1
Male	0.862 (0.566-1.313)	0.490
Age/year
≤60	1
>60	1.124 (0.740-1.706)	0.584
Cancer type
Lung cancer	1
Breast cancer	0.921 (0.550-1.542)	0.754
Gastric cancer	0.728 (0.420-1.262)	0.258
Gynecologic cancer	1.069 (0.494-2.316)	0.865
Cycle of chemotherapy
The first	1
The second	1.276 (0.707-2.303)	0.418
The third and above	0.816 (0.494-1.347)	0.426
Chemotherapy regimen
Low/minimal emetic risk chemotherapy	1		1
MEC	2.921 (1.021-8.355)	0.046	2.921 (1.021-8.355)	0.046
HEC	2.769 (1.006-7.626)	0.049	2.769 (1.006-7.626)	0.049

Characteristic	Univariate analysis		Multivariable analysis
Characteristic	OR (95% CI)	P value	OR (95% CI)	P value
Gender
Female	1		1
Male	0.475 (0.309-0.729)	<0.001	1.175 (0.673-2.052)	0.571
Age/year
≤60	1
>60	0.821 (0.541-1.245)	0.353
Cancer type
Lung cancer	1		1
Breast cancer	0.819 (0.476-1.411)	0.472	0.477 (0.253-0.902)	0.023
Gastric cancer	2.544 (1.467-4.411)	0.001	1.488 (0.744-2.974)	0.261
Gynecologic cancer	3.065 (1.387-6.774)	0.006	1.468 (0.582-3.707)	0.416
Cycle of chemotherapy
The first	1
The second	0.973 (0.539-1.754)	0.927
The third and above	0.834 (0.508-1.369)	0.473
Chemotherapy regimen
Low/minimal emetic risk chemotherapy	1		1
MEC	1.590 (0.548-4.610)	0.393	1.585 (0.529-4.744)	0.411
HEC	4.000 (1.454-11.003)	0.007	4.385 (1.535-12.529)	0.006

Characteristic	Univariate analysis		Multivariable analysis
Characteristic	OR（95% CI）	P value	OR（95% CI）	P value
Gender
Female	1		1
Male	0.499 (0.329-0.758)	0.001	1.521 (0.897-2.578)	0.120
Age/year
≤60	1
>60	0.830 (0.549-1.253)	0.374
Cancer type
Lung cancer	1		1
Breast cancer	0.702 (0.421-1.168)	0.173	0.524 (0.287-0.956)	0.035
Gastric cancer	1.598 (0.921-2.773)	0.095	0.997 (0.498-1.996)	0.992
Gynecologic cancer	1.720 (0.766-3.860)	0.189	0.875 (0.342-2.239)	0.780
Cycle of chemotherapy
The first	1
The second	1.045 (0.576-1.896)	0.886
The third and above	0.787 (0.480-1.293)	0.344
Chemotherapy regimen
Low/minimal emetic risk chemotherapy	1		1
MEC	3.471 (1.287-9.359)	0.014	3.240 (1.170-8.973)	0.024
HEC	4.986 (1.921-12.938)	<0.01	5.485 (2.043-14.726)	0.001

上海市癌症患者化疗所致恶心呕吐的横断面研究

Chemotherapy-induced nausea and vomiting among cancer patients in Shanghai: a cross-sectional study

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