Risk Factors And Prediction Of Myelosuppression In Patients With Lung Cancer After Platinum-containing Dual-drug Chemotherapy

Objectives: To investigate the independent risk factors of myelosuppression in patients with lung cancer after platinum-containing dual-drug chemotherapy.To develop and verify the clinical prediction model of myelosuppression after platinum-containing dual-drug chemotherapy in patients with lung cancer,for predicting the risk of myelosuppression after chemotherapy in lung cancer patients,guiding individual treatment and improve the quality of life of patients.Methods: Retrospective review was done on medical records of 437 patients with lung cancer who received platinum-containing dual-drug chemotherapy in Jinhua Municipal Central Hospital from January 2017 to December 2021.A total of 332 patients with lung cancer treated with platinum-containing dual-drug chemotherapy from January 2017 to December 2020 were defined as the model group,while the remaining 105 patients from January 2021 to December 2021 were defined as the validation group.The model group was divided into myelosuppression group and non-myelosuppression group according to whether there were myelosuppression after chemotherapy.The baseline characteristics of the patients,the laboratory tests and other clinical data were collected for comparison between the two groups to screen out the influencing factors with statistical significance(P<0.05).Using multivariate Logistic regression analysis to screen out the independent risk factors of myelosuppression in lung cancer patients after platinum-containing dual-drug chemotherapy.A clinical predictive model of myelosuppression after platinum-containing dual-drug chemotherapy in patients with lung cancer was established according to independent risk factors and clinical significance.Using the C-index,calibration curve and decision curve analysis to evaluate the predictive performance of the clinical prediction model.Results: 1.In this study,a total of 437 patients with lung cancer after dual-drug chemotherapy containing platinum were collected,including 325 patients with myelosuppression and 112 patients without myelosuppression.Univariate analysis showed that there were significant differences in chemotherapy regimen,targeting,postoperative adjuvant chemotherapy between the model group and the verification group,but no significant difference was found between sex,age,BMI,and comorbidities.2.Multivariate analysis shows that gender(OR 2.006,95% CI 1.042-3.833),BMI(OR0.838,95% CI 0.763-0.917),pre-chemotherapy leukocyte count(OR 0.853,95% CI0.762-0.945),pre-chemotherapy platelet count(OR 0.994,95% CI 0.991-0.998),targeted therapy(OR 3.51,95% CI 1.248-12.754)were independent risk factors for myelosuppression in patients with lung cancer after platinum-containing dual-drug chemotherapy(P<0.05).3.A clinical predictive model of myelosuppression after platinum-containing dual-drug chemotherapy in patients with lung cancer was established.The C-index of the prediction model of the model group was 0.764 [95% CI(0.707–0.822)] and that of the verification group was 0.715 [95% CI(0.609–0.822)].The clinical prediction model has good distinguishing ability.The calibration curve of the model demonstrates good agreement between prediction and observation in the model group.The decision curve analysis shows that using the prediction model can bring better clinical net benefit for lung cancer patients undergoing chemotherapy.Conclusions:1.variables of sex,BMI,white blood cell count before chemotherapy,platelet count before chemotherapy and targeted therapy are independent risk factors for myelosuppression in patients with lung cancer after platinum-containing dual-drug chemotherapy.2.The clinical prediction model of myelosuppression in lung cancer patients after platinum-containing dual-drug chemotherapy has good differentiation ability,calibration and clinical net benefit.It thus could be used to predict the probability of myelosuppression in lung cancer patients after platinum-containing dual-drug chemotherapy,guiding clinicians to take appropriate preventive measures before treatment.