Background

Granulocyte colony-stimulating factor (G-CSF) reportedly reduces the risk of neutropenia and subsequent infections caused by cancer chemotherapy. Although several guidelines recommend using G-CSF in primary prophylaxis according to the incidence rate of chemotherapy-induced febrile neutropenia (FN), the effectiveness of G-CSF in digestive system tumor chemotherapy remains unclear. To address these clinical questions, we conducted a systematic review as part of revising the Clinical Practice Guidelines for the Use of G-CSF 2022 published by the Japan Society of Clinical Oncology.

Methods

This systematic review addressed two main clinical questions (CQ): CQ1: “Is primary prophylaxis with G-CSF effective in chemotherapy?”, and CQ2: “Is increasing the intensity of chemotherapy with G-CSF effective?” We reviewed different types of digestive system tumors, including esophageal, gastric, pancreatic, biliary tract, colorectal, and neuroendocrine carcinomas. PubMed, Cochrane Library, and Ichushi-Web databases were searched for information sources. Independent systematic reviewers conducted two rounds of screening and selected relevant records for each CQ. Finally, the working group members synthesized the strength of evidence and recommendations.

Results

After two rounds of screening, 5/0/3/0/2/0 records were extracted for CQ1 of esophageal/gastric/pancreatic/biliary tract/colorectal/ and neuroendocrine carcinoma, respectively. Additionally, a total of 2/6/1 records were extracted for CQ2 of esophageal/pancreatic/colorectal cancer, respectively. The strength of evidence and recommendations were evaluated for CQ1 of colorectal cancer; however, we could not synthesize recommendations for other CQs owing to the lack of records.

Conclusion

The use of G-CSF for primary prophylaxis in chemotherapy for colorectal cancer is inappropriate.

中文翻译：

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G-CSF 在消化系统肿瘤化疗中的有效性：对日本临床肿瘤学会制定的 2022 年 G-CSF 使用临床实践指南的系统评价

背景

据报道，粒细胞集落刺激因子（G-CSF）可降低中性粒细胞减少症和癌症化疗引起的后续感染的风险。尽管一些指南根据化疗引起的发热性中性粒细胞减少症（FN）的发生率推荐使用G-CSF进行一级预防，但G-CSF在消化系统肿瘤化疗中的有效性仍不清楚。为了解决这些临床问题，我们进行了系统评价，作为修订日本临床肿瘤学会发布的 2022 年 G-CSF 使用临床实践指南的一部分。

方法

本系统评价解决了两个主要临床问题 (CQ)：CQ1：“G-CSF 一级预防在化疗中有效吗？”，CQ2：“增加 G-CSF 化疗强度有效吗？”我们回顾了不同类型的消化系统肿瘤，包括食管癌、胃癌、胰腺癌、胆道癌、结直肠癌和神经内分泌癌。在 PubMed、Cochrane 图书馆和 Ichushi-Web 数据库中搜索信息源。独立的系统评审员进行了两轮筛选，并为每个 CQ 选择了相关记录。最后，工作组成员综合了证据和建议的强度。

结果

经过两轮筛选，分别提取食管癌/胃癌/胰腺癌/胆道癌/结直肠癌/神经内分泌癌的CQ1 5/0/3/0/2/0条记录。此外，食管癌/胰腺癌/结直肠癌的CQ2分别总共提取了2/6/1条记录。对结直肠癌 CQ1 的证据和建议的强度进行了评估；然而，由于缺乏记录，我们无法综合其他 CQ 的建议。

结论

在结直肠癌化疗中使用 G-CSF 进行初级预防是不合适的。