The impact of rhG-CSF on risk of recurrence after postoperative chemotherapy in NSCLC Patients: A retrospective cohort study

Purpose: Recombinant human granulocyte colony-stimulating factor (rhG-CSF) is widespread in the prevention and treatment of blood-related toxic effects associated with chemotherapy. This study aimed to explore the correlation between rhG-CSF and the recurrence of non-small cell lung cancer (NSCLC) in patients who have undergone postoperative chemotherapy. Methods: Our study encompassed 517 NSCLC patients at pathological stage I-III, who underwent surgical removal and subsequent chemotherapy from January 2012 to December 2019 at the First Affiliated Hospital of Nanchang University. The research focused on evaluating the separate impact of rhG-CSF on the likelihood of postoperative recurrence. The analysis employed both univariate and multivariate Cox regression models. Results: Of 517 NSCLC patients, 123 patients did not receive rhG-CSF, while 394 patients received rhG-CSF. Unexpectedly, it was discovered that rhG-CSF usage correlated with the emergence of distant metastasis (HR: 1.8, 95 %CI 1.2-2.7, p = 0.005), though not with local recurrence (HR: 1.4, 95 %CI 0.9-2.3, p = 0.142). By multifactorial Cox analysis, rhG-CSF was an independent risk factor for distant metastasis (adjusted HR: 1.7, 95 %CI 1.0-2.6, p = 0.033). We additionally discovered that rhG-CSF could increase the risk of brain metastasis (adjusted HR: 3.9, 95 %CI 1.5-9.8, p = 0.005) and bone metastasis (adjusted HR: 3.1, 95 %CI 1.2-8.2, p = 0.02). Conclusion: Our findings indicate that rhG-CSF independently contributes to the risk of distant metastasis, yet it shows no correlation with local recurrence. Furthermore, employing rhG-CSF played a crucial role in predicting brain metastasis and bone metastasis after postoperative chemotherapy in NSCLC patients.