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首页> 外文学位 >Impact of Erythropoiesis Stimulating Agents on Survival and Risk of Venous Thromboembolism Among Patients with Colorectal Cancer Receiving Chemotherapy.
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Impact of Erythropoiesis Stimulating Agents on Survival and Risk of Venous Thromboembolism Among Patients with Colorectal Cancer Receiving Chemotherapy.

机译：红细胞生成刺激剂对接受化疗的结直肠癌患者生存率和静脉血栓栓塞风险的影响。

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摘要

Objectives. To describe utilization of erythropoiesis stimulating agents (ESAs) over time in the VA; to compare characteristics of ESA users with non-users among solid tumor patients receiving chemotherapy; and to evaluate the effect of ESA use on survival and risk of venous thromboembolism among colorectal cancer patients undergoing chemotherapy.;Methods. This study is a nonconcurrent prospective cohort study using the 2006--2008 Veterans Health Administration administrative data. There were two components to the study sample; 28,868 solid tumor patientseceiving chemotherapy to describe ESA utilization over time and 2,462 colorectal cancer patients receiving chemotherapy to estimate the effect of ESA on mortality and time to venous thromboembolism. A conventional multivariate adjusted and propensity score weighted Cox proportional hazard regressions were performed.;Results. Overall, 10% of solid tumor patients receiving chemotherapy in the cohort used ESAs at some time during the follow-up period. The proportion of ESA users among solid tumor patients decreased by half during the 2-year period. Use of ESA's during chemotherapy treatment was associated with a 2-fold increase in mortality. The estimated hazard ratios of ESA use for mortality among colorectal cancer patients receiving chemotherapy were 1.957 (95% CI = 1.522--2.517) in a conventional multivariate model and 2.045 (95% CI = 1.799--2.326) in a propensity score weighted model.;Conclusion. This population-based observational study demonstrated that the use of ESAs declined over time in the VA healthcare system between July 2006 and August 2008 and showed survival was decreased with the combination use of chemotherapy plus ESAs compared with chemotherapy alone. While gaps in the available data elements, particularly cancer staging, and other potential biases inherent in observational studies must be considered when interpreting these results, the study's findings are consistent with the clinical trials at other cancer sites and the meta-analyses which combined cancer sites suggesting that the decreases in survival are not site dependent. This provides important insight regarding a fair balance of risks and benefits for the management of anemia by the combination use of chemotherapy and ESAs in colorectal cancer population.
机译：目标。描述随着时间的流逝在VA中使用促红细胞生成因子（ESA）的方法；比较接受化疗的实体瘤患者中ESA使用者和非使用者的特征；并评估ESA的使用对接受化疗的大肠癌患者生存率和静脉血栓栓塞风险的影响。本研究是使用2006--2008退伍军人卫生管理局的行政数据进行的非同期前瞻性队列研究。研究样本有两个组成部分： 28868例接受化疗以描述ESA在一段时间内的利用率的实体瘤患者和2462例接受化疗以评估ESA对死亡率和静脉血栓栓塞时间的影响的结直肠癌患者。结果进行了常规的多元调整和倾向得分加权Cox比例风险回归分析。总体而言，队列中接受化疗的实体瘤患者中有10％在随访期间的某些时间使用了ESA。在两年期间，实体瘤患者中使用ESA的比例下降了一半。化学疗法期间使用ESA可使死亡率增加2倍。在传统的多变量模型中，接受化疗的结直肠癌患者中ESA死亡的估计危险比为1.957（95％CI = 1.522--2.517），在倾向评分加权模型中为2.045（95％CI = 1.799--2.326） 。;结论。这项基于人群的观察性研究表明，在2006年7月至2008年8月之间，VA医疗系统中ESA的使用随着时间的推移而下降，并显示与单独化疗相比，联合使用化学疗法和ESA可以降低生存率。在解释这些结果时，虽然必须考虑可用数据元素的差距，尤其是癌症的分期以及观察性研究固有的其他潜在偏见，但研究结果与其他癌症部位的临床试验以及结合癌症部位的荟萃分析一致提示存活率下降与部位无关。这为通过在结直肠癌人群中联合使用化学疗法和ESA来平衡贫血的风险和收益之间的平衡提供了重要的见识。

著录项

  • 作者

    Sato, Masayo.;

  • 作者单位

    University of Maryland, Baltimore.;

  • 授予单位 University of Maryland, Baltimore.;
  • 学科 Health Sciences Epidemiology.;Health Sciences Oncology.
  • 学位 Ph.D.
  • 年度 2012
  • 页码 132 p.
  • 总页数 132
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 地球物理学;
  • 关键词

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