Meta-analysis of neutropenia or leukopenia as a prognostic factor in patients with malignant disease undergoing chemotherapy.
OBJECTIVE
We performed a systematic review and meta-analysis to determine the impact of neutropenia or leukopenia experienced during chemotherapy on survival.


METHODS
Eligible studies included prospective or retrospective analyses that evaluated neutropenia or leukopenia as a prognostic factor for overall survival or disease-free survival. Statistical analyses were conducted to calculate a summary hazard ratio and 95% confidence interval (CI) using random-effects or fixed-effects models based on the heterogeneity of the included studies.


RESULTS
Thirteen trials were selected for the meta-analysis, with a total of 9,528 patients. The hazard ratio of death was 0.69 (95% CI, 0.64-0.75) for patients with higher-grade neutropenia or leukopenia compared to patients with lower-grade or lack of cytopenia. Our analysis was also stratified by statistical method (any statistical method to decrease lead-time bias; time-varying analysis or landmark analysis), but no differences were observed.


CONCLUSIONS
Our results indicate that neutropenia or leukopenia experienced during chemotherapy is associated with improved survival in patients with advanced cancer or hematological malignancies undergoing chemotherapy. Future prospective analyses designed to investigate the potential impact of chemotherapy dose adjustment coupled with monitoring of neutropenia or leukopenia on survival are warranted.
Shitara
Kohei
K
Department of Clinical Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan.
Matsuo
Keitaro
K
Oze
Isao
I
Mizota
Ayako
A
Kondo
Chihiro
C
Nomura
Motoo
M
Yokota
Tomoya
T
Takahari
Daisuke
D
Ura
Takashi
T
Muro
Kei
K
D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007970:Leukopenia / Q000139:chemically induced*; D009369:Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced*; D011379:Prognosis; D016019:Survival Analysis
D000970:Antineoplastic Agents