Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
Clin Transl Oncol. 2011 Jun;13(6):426-9. doi: 10.1007/s12094-011-0677-y.
Oncologists should carefully weigh up the risks and benefits of palliative chemotherapy in patients with advanced solid tumours (AST) and poor general status from the standpoint both of medical and ethical issues and of healthcare resources required. This study is intended to assess the impact on overall survival of palliative chemotherapy in patients with AST and admitted to hospital as a result of their poor ECOG status.
We performed a retrospective analysis of 92 hospitalised patients with AST, ECOG 3-4, who were treated with palliative chemotherapy. Uni- and multivariate statistical analyses were conducted to determine the impact of clinical and disease variables (number of previous chemotherapy lines, presence of comorbidities, presentation of anorexia-cachexia syndrome, delirium, dyspnoea, ascitis, brain metastases, T-cell count, albumin, haemoglobin and LDH) on survival in this patient population.
Mean age was 54 years (range 15-80). No chemotherapy had been given for advanced disease in 74%, 13% had received one line, 6% 2 lines and 7% ≥3 lines. Median survival, i.e., after initiation of chemotherapy to death, in these patients was 33 days (range 1-1390). The median of chemotherapy cycles was 1. In the multivariate analysis, no previous chemotherapy, and absence of anorexia-cachexia syndrome and of comorbidities was associated with significantly improved survival in patients. Forty-nine percent of patients died within 30 days of therapy, 28% died between days 30 and 90, and only 23% of patients lived longer than 90 days. Grade 3-4 toxicities mainly entailed blood disorders, namely anaemia 8%, neutropenia 13% and thrombocytopenia 8%. Six patients (5%) developed sepsis after therapy; of these, 3 died from this toxicity, 1 patient suffered cardiac toxicity, one patient leukoencephalopathy and 1 patient acute pulmonary thromboembolism.
Palliative chemotherapy given to patients with AST and ECOG 3-4 with short life expectancy provided no benefit for survival. As a result, we may be over-treating these patients and contributing to poor-quality care.
从医学和伦理问题以及所需医疗资源的角度出发，肿瘤学家应仔细权衡晚期实体瘤（AST）且体能状态差的患者进行姑息化疗的风险和获益。本研究旨在评估姑息化疗对因体能状态差而住院的 AST 患者的总生存期的影响。
我们对 92 例 AST 且 ECOG 评分为 3-4 的住院患者进行了回顾性分析，这些患者接受了姑息化疗。采用单因素和多因素统计分析方法来确定临床和疾病变量（化疗线数、合并症存在、厌食-恶病质综合征、谵妄、呼吸困难、腹水、脑转移、T 细胞计数、白蛋白、血红蛋白和 LDH）对该患者人群生存的影响。
患者平均年龄为 54 岁（15-80 岁）。74%的患者既往未接受过晚期疾病化疗，13%的患者接受过一线化疗，6%的患者接受过二线化疗，7%的患者接受过≥3 线化疗。这些患者的中位生存期（即从开始化疗到死亡的时间）为 33 天（1-1390 天）。化疗周期的中位数为 1 个周期。在多因素分析中，无既往化疗、无厌食-恶病质综合征和无合并症与患者的生存显著改善相关。49%的患者在治疗后 30 天内死亡，28%的患者在 30-90 天内死亡，只有 23%的患者生存期超过 90 天。3-4 级毒性主要涉及血液系统疾病，即贫血 8%、中性粒细胞减少 13%和血小板减少 8%。6 例（5%）患者在治疗后发生脓毒症；其中 3 例因该毒性死亡，1 例发生心脏毒性，1 例发生白细胞脑病，1 例发生急性肺血栓栓塞症。
对 AST 且 ECOG 评分为 3-4 且预期寿命较短的患者进行姑息化疗并未改善其生存获益。因此，我们可能过度治疗了这些患者，并导致了较差的护理质量。
