Hsieh Ching-Chuan, Weng Hsu-Huei, Huang Wen-Shih, Wang Wen-Ke, Kao Chiung-Lun, Lu Ming-Shian, Wang Chia-Siu
Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 613, Taiwan, China.
World J Gastroenterol. 2009 Oct 7;15(37):4709-14. doi: 10.3748/wjg.15.4709.
To analyze the risk factors for central port failure in cancer patients administered chemotherapy, using univariate and multivariate analyses.
A total of 1348 totally implantable venous access devices (TIVADs) were implanted into 1280 cancer patients in this cohort study. A Cox proportional hazard model was applied to analyze risk factors for failure of TIVADs. Log-rank test was used to compare actuarial survival rates. Infection, thrombosis, and surgical complication rates (chi(2) test or Fisher's exact test) were compared in relation to the risk factors.
Increasing age, male gender and open-ended catheter use were significant risk factors reducing survival of TIVADs as determined by univariate and multivariate analyses. Hematogenous malignancy decreased the survival time of TIVADs; this reduction was not statistically significant by univariate analysis [hazard ratio (HR) = 1.336, 95% CI: 0.966-1.849, P = 0.080)]. However, it became a significant risk factor by multivariate analysis (HR = 1.499, 95% CI: 1.079-2.083, P = 0.016) when correlated with variables of age, sex and catheter type. Close-ended (Groshong) catheters had a lower thrombosis rate than open-ended catheters (2.5% vs 5%, P = 0.015). Hematogenous malignancy had higher infection rates than solid malignancy (10.5% vs 2.5%, P < 0.001).
Increasing age, male gender, open-ended catheters and hematogenous malignancy were risk factors for TIVAD failure. Close-ended catheters had lower thrombosis rates and hematogenous malignancy had higher infection rates.
采用单因素和多因素分析方法，分析接受化疗的癌症患者中心静脉置管失败的危险因素。
在这项队列研究中，共1280例癌症患者植入了1348根全植入式静脉通路装置（TIVAD）。应用Cox比例风险模型分析TIVAD失败的危险因素。采用对数秩检验比较累积生存率。针对危险因素比较感染、血栓形成和手术并发症发生率（卡方检验或Fisher精确检验）。
单因素和多因素分析均显示，年龄增加、男性以及使用开放式导管是TIVAD生存率降低的显著危险因素。血液系统恶性肿瘤缩短了TIVAD的生存时间；单因素分析时这种缩短无统计学意义[风险比（HR）=1.336，95%置信区间（CI）：0.966 - 1.849，P = 0.08]。然而，与年龄、性别和导管类型等变量相关时，多因素分析显示其成为显著危险因素（HR = 1.499，95% CI：1.079 - 2.083，P = 0.016）。封闭式（Groshong）导管的血栓形成率低于开放式导管（2.5%对5%，P = 0.015）。血液系统恶性肿瘤的感染率高于实体恶性肿瘤（10.5%对2.5%，P < 0.001）。
年龄增加、男性、开放式导管和血液系统恶性肿瘤是TIVAD失败的危险因素。封闭式导管血栓形成率较低，血液系统恶性肿瘤感染率较高。
