内容紹介
Summary
Background: A side effect of anti-angiogenic agent treatment is proteinuria. Evaluation of the severity of adverse effects and the decision to discontinue treatment is based on the qualitative analysis of urinary proteins. However, a qualitative analysis result may not be indicative of the actual amounts of protein excreted. In this study, we evaluated the possibility of using the urine protein/creatinine ratio(UPCR), instead of a qualitative urine analysis, to monitor patients treated with anti-angiogenic agents. Methods: Urinalysis data of patients receiving anti-angiogenic agents-bevacizumab, ramucirumab, or aflibercept-were retrospectively analyzed from clinical records. A correlation between the urine protein content(qualitative and quantitative analyses)and continuity of anti-angiogenic agent treatment was evaluated. Results: A total of 24 patients(age, 70.83±7.45 years)who received treatment for colorectal cancer(n=17), lung cancer(n=4), gastric cancer(n=2), and breast cancer(n=1)were included. One hundred and sixty-five urinalysis results were collected. A linear correlation between the qualitative urinalysis results(1+ to 3+)and UPCR(r=0.746, p<0.01)was obtained. In patients with a urine protein content of 2+(qualitative analysis), the UPCR was <2.0 for 25 patients and >_2.0 but <3.5 for 4 patients. Similarly, in patients with a urine protein content of 3+, the UPCR was <2.0 for 3 patients and >_2.0 but <3.5 for 1 patient. Seventeen patients with a urine protein content of 2+ and 3 patients with a urine protein content of 3+ discontinued treatment with anti-angiogenic agents before estimation of the UPCR could be performed. These figures were reduced to 4 patients and 2 patients, respectively, following UPCR assessment. Conclusions: Switching the estimation of proteinuria from a qualitative analysis to UPCR might lead to better safety monitoring and prevent unnecessary discontinuation of anti-angiogenic agent treatment.
要旨
背景: 血管新生阻害薬使用時の副作用として尿蛋白がある。これまで尿蛋白定性の結果を治療継続の判断としていた。近年,尿蛋白/クレアチニン比(urine protein/creatinine ratio: UPCR)の有用性が報告されており,その有用性を調査した。方法: 血管新生阻害薬としてベバシズマブなどを投与した患者24名(年齢70.83±7.45歳,大腸がん17名,肺がん4名,胃がん2名,乳がん1名)の尿検査および採血,PFSを診療録より後方視的に調査し,尿定性とUPCRの結果を比較した。結果: 24名,165件の検査値が得られ,尿定性2+が出現した症例では,UPCRが2.0未満25件,2.0以上3.5未満が4件であった。尿定性3+が出現した症例では,UPCRが2.0未満3件,2.0以上3.5未満が1件であった。尿定性結果とUPCRの相関はr=0.746であった。UPCR測定導入前に,尿定性2+および3+のみの結果により中止していた件数は,それぞれ17件および3件であった。これらはUPCR測定導入により,それぞれ4件および2件に減少すると考えられた。結論: 血管新生阻害薬使用時の蛋白尿検査を定性からUPCRへ変更することで尿定性が2+以上の場合,不必要な中止を避け,安全な継続使用に有用であると思われた。
目次
Background: A side effect of anti-angiogenic agent treatment is proteinuria. Evaluation of the severity of adverse effects and the decision to discontinue treatment is based on the qualitative analysis of urinary proteins. However, a qualitative analysis result may not be indicative of the actual amounts of protein excreted. In this study, we evaluated the possibility of using the urine protein/creatinine ratio(UPCR), instead of a qualitative urine analysis, to monitor patients treated with anti-angiogenic agents. Methods: Urinalysis data of patients receiving anti-angiogenic agents-bevacizumab, ramucirumab, or aflibercept-were retrospectively analyzed from clinical records. A correlation between the urine protein content(qualitative and quantitative analyses)and continuity of anti-angiogenic agent treatment was evaluated. Results: A total of 24 patients(age, 70.83±7.45 years)who received treatment for colorectal cancer(n=17), lung cancer(n=4), gastric cancer(n=2), and breast cancer(n=1)were included. One hundred and sixty-five urinalysis results were collected. A linear correlation between the qualitative urinalysis results(1+ to 3+)and UPCR(r=0.746, p<0.01)was obtained. In patients with a urine protein content of 2+(qualitative analysis), the UPCR was <2.0 for 25 patients and >_2.0 but <3.5 for 4 patients. Similarly, in patients with a urine protein content of 3+, the UPCR was <2.0 for 3 patients and >_2.0 but <3.5 for 1 patient. Seventeen patients with a urine protein content of 2+ and 3 patients with a urine protein content of 3+ discontinued treatment with anti-angiogenic agents before estimation of the UPCR could be performed. These figures were reduced to 4 patients and 2 patients, respectively, following UPCR assessment. Conclusions: Switching the estimation of proteinuria from a qualitative analysis to UPCR might lead to better safety monitoring and prevent unnecessary discontinuation of anti-angiogenic agent treatment.
要旨
背景: 血管新生阻害薬使用時の副作用として尿蛋白がある。これまで尿蛋白定性の結果を治療継続の判断としていた。近年,尿蛋白/クレアチニン比(urine protein/creatinine ratio: UPCR)の有用性が報告されており,その有用性を調査した。方法: 血管新生阻害薬としてベバシズマブなどを投与した患者24名(年齢70.83±7.45歳,大腸がん17名,肺がん4名,胃がん2名,乳がん1名)の尿検査および採血,PFSを診療録より後方視的に調査し,尿定性とUPCRの結果を比較した。結果: 24名,165件の検査値が得られ,尿定性2+が出現した症例では,UPCRが2.0未満25件,2.0以上3.5未満が4件であった。尿定性3+が出現した症例では,UPCRが2.0未満3件,2.0以上3.5未満が1件であった。尿定性結果とUPCRの相関はr=0.746であった。UPCR測定導入前に,尿定性2+および3+のみの結果により中止していた件数は,それぞれ17件および3件であった。これらはUPCR測定導入により,それぞれ4件および2件に減少すると考えられた。結論: 血管新生阻害薬使用時の蛋白尿検査を定性からUPCRへ変更することで尿定性が2+以上の場合,不必要な中止を避け,安全な継続使用に有用であると思われた。