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Q1. 依據 NCCN guideline, 若是病人屬於 high risk of neutropenia, 會建議預防使用 G-CSF，請問 high risk 是指大於?

  • (A) 10%
  • (B) 20%
  • (C) 30%
  • (D) 40%
點此顯示正解

(B) 20%

詳解

The correct answer is (B) 20% because the NCCN Hematopoietic Growth Factors guideline, ASCO, and EORTC all define high risk for febrile neutropenia as >20%, which is the threshold for recommending primary prophylactic G-CSF.

Why 20% is the threshold:

According to the NCCN Hematopoietic Growth Factors guideline, patients are stratified into three risk categories based on their expected risk of febrile neutropenia12:

  • High risk (>20%): Primary prophylaxis with G-CSF is recommended (Category 1 recommendation)
  • Intermediate risk (10-20%): G-CSF prophylaxis should be considered based on patient-specific risk factors (age >65 years, prior chemotherapy/radiation, bone marrow involvement, liver/renal dysfunction, recent surgery, persistent neutropenia)
  • Low risk (<10%): G-CSF is not routinely recommended, but may be considered in patients with ≥2 risk factors

This 20% threshold is consistently endorsed across major guidelines. The ASCO 2015 guideline update by Smith et al. states: "Prophylactic use of CSFs to reduce the risk of febrile neutropenia is warranted when the risk of febrile neutropenia is approximately 20% or higher and no other equally effective and safe regimen that does not require CSFs is available"3[^7]. The most recent ASCO 2026 guideline update reaffirms this same threshold[^6].

Why the other options are incorrect:

  • (A) 10%: This represents the lower bound of intermediate risk, not high risk. At 10-20% risk, prophylaxis is only considered based on additional patient factors, not routinely recommended12
  • (C) 30% and (D) 40%: These percentages are well above the threshold and would certainly warrant prophylaxis, but they are not the defined cutoff. The guideline-established threshold is >20%

The 20% threshold has been validated in multiple studies and represents the point at which the benefits of G-CSF prophylaxis (reduced febrile neutropenia, hospitalizations, and infection-related mortality) outweigh the risks and costs of routine prophylactic use3[7][9].

詳解 · 中文翻譯

正確答案是 (B) 20%，因為 NCCN 造血生長因子指南、ASCO 和 EORTC 都定義 發熱性中性粒細胞減少症高風險為 >20%，這是推薦初級預防性 G-CSF 的閾值。

為何 20% 是閾值：

根據 NCCN 造血生長因子指南，患者根據其預期的發熱性中性粒細胞減少症風險分為三個風險類別12：

  • 高風險 (>20%)：初級預防性 G-CSF 推薦 (第 1 級建議)
  • 中等風險 (10-20%)：應根據患者特異性風險因素（年齡 >65 歲、既往化療/放療、骨髓浸潤、肝/腎功能不全、近期手術、持續中性粒細胞減少症）考慮 G-CSF 預防
  • 低風險 (<10%)：G-CSF 不常規推薦，但可在具有 ≥2 個風險因素的患者中考慮

此 20% 閾值在主要指南中得到一致認可。Smith 等人的 ASCO 2015 指南更新指出：「當發熱性中性粒細胞減少症風險約為 20% 或更高且沒有其他同樣有效且安全的不需要 CSF 的方案時，建議預防性使用 CSF」3[^7]。最近的 ASCO 2026 指南更新重申同一閾值[^6]。

其他選項為何不正確：

  • (A) 10%：這代表 中等風險的下限，而非高風險。在 10-20% 風險時，預防只基於額外患者因素考慮，不是常規推薦12
  • (C) 30% 和 (D) 40%：這些百分比遠高於閾值，肯定會保證預防，但它們不是定義的截斷點。指南確定的閾值是 >20%

20% 閾值已在多項研究中得到驗證，代表 G-CSF 預防的益處（減少發熱性中性粒細胞減少症、住院和感染相關死亡率）超過常規預防性使用的風險和成本的點3[7][9]。

參考文獻 (AMA)

  1. National Comprehensive Cancer Network. Hematopoietic Growth Factors. https://www.nccn.org/professionals/physician_gls/pdf/growthfactors.pdf#page=8. ↩↩↩↩

  2. Smith TJ, Bohlke K, Lyman GH, et al. Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2015;33(28):3199-212. doi:10.1200/JCO.2015.62.3488. PMID:26169616. ↩↩↩↩

  3. Gyawali B, Bohlke K, Dickter JK, et al. WBC Growth Factors: ASCO Guideline Update. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 2026;44(9):812-824. doi:10.1200/JCO-25-02938. PMID:41740078. ↩↩↩↩

  4. Procopio G, Niger M, Testa I. Lecture: Management of Chemotherapy-Induced Febrile Neutropenia; Guidelines and Colony Stimulating Factors. Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2011;32 Suppl 2:S217-9. doi:10.1007/s10072-011-0795-x. PMID:22002072. ↩

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