Risk Factors of Moderate to Severe Chemotherapy-Induced Anemia in Ovarian Cancer Patients Treated with Paclitaxel + Carboplatin Regimens

Abstract

Among the total incidence of chemotherapy-induced anemia (CIA) in epithelial ovarian cancer (EOC) patients treated with paclitaxel/carboplatin regimens of 92.8%, there are 64.4% in moderate to severe CIA which may be lethal. The etiology of moderate to severe CIA is multifactorial, including cu­mulative dose of paclitaxel and/or carboplatin. There is no previous study to elaborate the risk factors of moderate to severe CIA in these cases, and thus, it was the objectives of this study. It was conducted as a retrospective cohort study in a general hospital after institutional ethical approval. Cases were recruited from in-patient records if all of the inclusion criteria were met, i.e. diagnosed with epithelial ovarian cancer and treated with paclitaxel+carboplatin regimens between 2009 and 2016. Data from all recruited cases included the stages of diseases classified by International Federation of Gynecology and Obstetrics (FIGO), hemoglobin and hematocrit levels (baseline and within 3 weeks after received chemotherapy in each cycle), chemotherapy cycles, average doses, cumulative doses, etc. Moderate to severe CIA was defined as a hemoglobin level below 10 g/dL within 3 weeks after received chemotherapy. Significant risk factors between groups primarily identified by univariate analysis (p<0.05) were selected for further analysis by backward multivariable logistic regression for a receiver operating characteristic (ROC) curve. There were 82 eligible cases, of whom 45 (54.9%) were categorized as cases with moderate to severe CIA. Backward multivariable logistic regression analysis suggested statistical significances in moderate to severe CIA cases with >50 years (OR=3.97; p=0.008) and carboplatin cumulative doses of over 3,950 mg (OR=10.30; p=0.044). ROC curve analysis of the risk factors predicted 74.3% of moderate to se­vere CIA. In conclusion, EOC cases who were over 50 years treated with cumulative doses of carboplatin of over 3,950 mg were at significant risk and should be further monitored clinically.