Brief Article
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World J Gastroenterol. Feb 14, 2014; 20(6): 1565-1573
Published online Feb 14, 2014. doi: 10.3748/wjg.v20.i6.1565
Prognostic value of chemotherapy-induced hematological toxicity in metastatic colorectal cancer patients
Laurie Rambach, Aurelie Bertaut, Julie Vincent, Veronique Lorgis, Sylvain Ladoire, Francois Ghiringhelli
Laurie Rambach, Julie Vincent, Veronique Lorgis, Sylvain Ladoire, Francois Ghiringhelli, Department of Medical Oncology, Centre Georges-François Leclerc, 21000 Dijon, France
Aurelie Bertaut, Biostatistics and Epidemiological Unit, EA 4184, Centre Georges-François Leclerc, 21000 Dijon, France
Julie Vincent, Sylvain Ladoire, Francois Ghiringhelli, Institut National de la , Santé et de la Recherche Médicale (INSERM), CRI-866 Faculty of Medicine, 21000 Dijon, France
Julie Vincent, Sylvain Ladoire, Francois Ghiringhelli, School of Medicine, University of Burgundy, 21000 Dijon, France
Author contributions: Rambach L and Bertaut A contributed equally to this work; Rambach L collected the data; Bertaut A performed the statistical analysis; Vincent J, Lorgis V and Ghiringhelli F included patients; Ghiringhelli F and Ladoire S designed the study and wrote the manuscript.
Correspondence to: Francois Ghiringhelli, MD, PhD, Department of Medical Oncology, Georges-Francois Leclerc Cancer Center, INSERM Avenir 866, 1 rue du Professeur Marion, 21000 Dijon, France. fghiringhelli@cgfl.fr
Telephone: +33-380-737500 Fax: +33-380-737500
Received: September 17, 2013
Revised: November 15, 2013
Accepted: December 3, 2013
Published online: February 14, 2014
Abstract

AIM: To establish whether chemotherapy-induced neutropenia is predictive of better outcome in patients with metastatic colorectal cancer (mCRC).

METHODS: Survival and patient characteristics from consecutive mCRC patients treated in the Centre Georges Francois Leclerc, Dijon, France between January 2001 and December 2011 were analyzed. Patient and tumor characteristics, hematological toxicity (neutropenia, anemia, and thrombocytopenia), and type of chemotherapy received were recorded.

RESULTS: We retrospectively analyzed data from 399 consecutive patients with mCRC who received at least one line of chemotherapy. Median follow up was 6.3 years. Eighty-eight percent of the patients received more than two lines of chemotherapy. By univariate analysis, whatever their grade, neutropenia and thrombocytopenia occurring during the first two lines of chemotherapy were significantly associated with better overall survival (HR = 0.55, 95%CI: 0.43-0.70, P < 0.0001 and HR = 0.70, 95%CI: 0.56-0.88, P = 0.025 respectively). In contrast, anemia during chemotherapy was significantly associated with poorer overall survival (HR = 1.9, 95%CI: 1.22-2.97, P = 0.005). Multivariate analysis revealed that both neutropenia and thrombocytopenia were significantly associated with better overall survival: HR = 0.43, 95%CI: 0.29-0.64, P < 0.0001 and HR = 0.69, 95%CI: 0.49-0.98, P = 0.036, respectively.

CONCLUSION: These data suggest that occurrence of neutropenia or thrombocytopenia during first- or second-line chemotherapy for mCRC is associated with better survival.

Keywords: Colorectal cancer, Metastasis, Prognostic factor, Neutropenia, Chemotherapy

Core tip: Using a retrospective database of 399 patients we aimed to establish whether chemotherapy-induced cytopenia was predictive of better outcome in patients with metastatic colorectal cancer. We observed that occurrence of neutropenia and thrombocytopenia was associated with better outcome, while occurrence of anemia was associated with poorer outcome.