Recombinant Human Granulocyte Colony-Stimulating Factor is Associated with Increased Risk of Metastasis in NSCLC Patients Following Postoperative Chemotherapy: A Retrospective Cohort Study

Abstract

Background: Recombinant human granulocyte colony-stimulating factor (rhG-CSF), which can reduce neutropenia events, is widely used in cancer patients receiving chemotherapy. However, the effects of rhG-CSF on distant organ metastasis (DOM) in non-small cell lung cancer (NSCLC) patients following postoperative chemotherapy remain unclear.Methods: A retrospective cohort study was performed on NSCLC patients who suffered complete surgical resection and postoperative system chemotherapy at The First Affiliated Hospital of Nanchang University between 1 January 2012 and 31 December 2017. The effect of rhG-CSF on DOM was assessed, regulating with other confounding factors using Cox regression analyses.Results: We identified 307 NSCLC patients who received postoperative system chemotherapy (n=246 rhG-CSF group, n=61 No rhG-CSF group). The incidence of DOM in postoperative NSCLC patients with rhG-CSF treatment was observably higher than without rhG-CSF (48.3% vs. 27.9%, p<0.05). Univariate regression analysis revealed that rhG-CSF and clinical stage were the independent risk factor of Metastasis-free survival (MFS) (p<0.05). rhG-CSF users had a higher risk of DOM (adjusted HR: 2.33, 95% CI: 1.31-4.15) than nonusers of rhG-CSF. The association between rhG-CSF and risk of DOM was significant only among patients presenting with myelosuppression (HR: 3.34, 95% CI: 1.86-6.02), not among those without myelosuppression (HR: 0.71, 95% CI: 0.17-2.94, Interaction p-value<0.01). The risk increased with higher dosage density of rhG-CSF use, comparing those using rhG-CSF versus no users (p for trend<0.001).Conclusion These analyses indicated that rhG-CSF use is related to DOM following postoperative chemotherapy in NSCLC.