title: Chemotherapy-induced neutropenia as a prognostic factor in patients with unresectable pancreatic cancer.
abstract: OBJECTIVE
  We conducted a retrospective cohort study to examine whether neutropenia could be an indicator of good prognosis in patients treated with gemcitabine (GEM) for unresectable pancreatic cancer.
  
  
  METHODS
  A total of 178 patients with unresectable pancreatic cancer, who were treated with first-line (n = 121) or second-line (n = 57) GEM, were included in our analyses. A Cox proportional hazard model was used to examine the effect of the grade of GEM-induced neutropenia on prognosis. Furthermore, the difference in survival time for each grade was assessed using a log-rank test.
  
  
  RESULTS
  In the first-line population, the hazard ratios of patients with grade 2 or grade 3 neutropenia compared with the ratios of those without neutropenia (grade 0) were 0.43 (95% CI 0.27-0.70) and 0.37 (0.21-0.65), respectively (p < 0.05). The median survival time (MST) was 3.8 months for grade 0, 9.4 months for grade 2, and 10.1 for grade 3. Landmark analysis of the second-line population revealed a hazard ratio of 0.52 (0.30-0.82) for grade 1 and 0.49 for grade 2 (0.28-0.72) (p < 0.05). MST was 1.3 months for grade 0, 4.7 months for grade 1, and 4.6 months for grade 2.
  
  
  CONCLUSIONS
  We found that neutropenia grade was an indicator of good prognosis in patients treated with first-line and second-line GEM for unresectable pancreatic cancer. A prospective study should be performed to examine whether dosage adjustment using neutropenia grade as an indicator would improve prognosis.
authors.affiliation: Division of Physiology and Pathology, Department of Pharmacology, Toxicology and Therapeutics, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan. kurihara@pharm.showa-u.ac.jp.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kurihara
authors.affiliation: Department of Hospital Pharmaceutics, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Kogo
authors.affiliation: Division of Physiology and Pathology, Department of Pharmacology, Toxicology and Therapeutics, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ishii
authors.affiliation: Division of Medical Oncology, Department of Medicine, Showa University Koto-Toyosu Hospital, 1-5-8 Hatanodai, Koto-ku, Tokyo, 135-0061, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Shimada
authors.affiliation: Health Service Center, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Yoneyama
authors.affiliation: Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Kitamura
authors.affiliation: Division of Physiology and Pathology, Department of Pharmacology, Toxicology and Therapeutics, Showa University School of Pharmacy, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yoshida
authors.affiliation: Center of Pharmaceutical Education, School of Pharmaceutical Sciences, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kiuchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010190:Pancreatic Neoplasms / Q000188:drug therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine
keywords: Gemcitabin; Neutropenia; Prognosis; Unresectable pancreatic cancer