Chan Richie Chiu-Lung, Chan Yiu Che, Cheng Stephen Wing-Keung
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong.
Interact Cardiovasc Thorac Surg. 2013 Apr;16(4):455-8. doi: 10.1093/icvts/ivs562. Epub 2013 Jan 10.
Superior vena cava obstruction (SVCO) due to mitotic diseases is a serious condition with significant morbidity and mortality. The aim of this study was to examine the follow-up data and demographics of patients with SVCO admitted to the Department of Surgery, Queen Mary Hospital, over a 14-year period.
The prospectively entered clinical data of patients with SVCO in Queen Mary Hospital from October 1997 to September 2011 were retrospectively analysed. All patient records were electronically and manually searched. Survival was calculated using Kaplan-Meier survival curves analysis. The Mantel-Cox log-rank test was used to test for statistically significant differences. Demographic data, associated aetiology, intervention and outcome were studied. Only patients with malignant aetiologies were included.
A total of 104 patients (81 males and 23 females) were recruited in our study period. Median age at presentation was 65 (range 3-91 years). The median follow-up period was 2 months. The commonest cause of SVCO was bronchogenic carcinoma (71%), followed by extrathoracic malignancies (16%), lymphoma (8%) and thymic malignancy (3%). The mean time from the onset of symptoms to presentation was 34 days. Steroids were prescribed for most (93.9%) of the patients. About half (54.4%) of the patients were given radiotherapy. Only 7 patients had angioplasty and all of them had stents inserted. The overall survival was poor. The mean and median survivals were 8.4 and 1.6 months, respectively. Seventeen percent of patients died in the same hospitalization as for their initial presentations. Younger age (50 years or below; P = 0.000), never smoker (P = 0.012), not using steroids (P = 0.007) and certain primary aetiologies (e.g. lymphoma; P = 0.008) were associated with longer overall survival on univariate analysis. However, on multivariate analysis, none of these factors reached statistical significance. The mean survival for cases with lymphoma, extrathoracic malignancies, bronchogenic tumours and thymic tumours was 80.1, 3.4, 3.1 and 1.8 months, respectively. Angioplasty did not show a statistically significant association with the overall survival.
This study, to the best of our knowledge, is the first to study the prognostic factors that may affect survival outcome in malignant SVCO. We showed that in patients with malignant aetiology for SVCO, advanced age (more than 50), history of smoking and use of steroids were statistically significantly associated with a poor outcome. The underlying primary malignant aetiology also has an important prognostic significance. Despite advances in medicine, the prognosis of patients with SVCO is still grave.
有丝分裂疾病导致的上腔静脉阻塞（SVCO）是一种严重疾病，具有较高的发病率和死亡率。本研究旨在调查在14年期间入住玛丽医院外科的SVCO患者的随访数据和人口统计学特征。
回顾性分析1997年10月至2011年9月在玛丽医院前瞻性录入的SVCO患者的临床数据。对所有患者记录进行电子和人工检索。使用Kaplan-Meier生存曲线分析计算生存率。采用Mantel-Cox对数秩检验来检验统计学上的显著差异。研究人口统计学数据、相关病因、干预措施和结果。仅纳入病因恶性的患者。
在我们的研究期间共招募了104例患者（81例男性和23例女性）。就诊时的中位年龄为65岁（范围3 - 91岁）。中位随访期为2个月。SVCO最常见病因是支气管源性癌（71%），其次是胸外恶性肿瘤（16%）、淋巴瘤（8%）和胸腺恶性肿瘤（3%）。从症状出现到就诊的平均时间为34天。大多数患者（93.9%）使用了类固醇。约一半（54.4%）的患者接受了放疗。只有7例患者进行了血管成形术，且均植入了支架。总体生存率较差。平均生存时间和中位生存时间分别为8.4个月和1.6个月。17%的患者在首次就诊的同一住院期间死亡。单因素分析显示，年龄较轻（50岁及以下；P = 0.000）、从不吸烟（P = 0.012）、未使用类固醇（P = 0.007）以及某些原发性病因（如淋巴瘤；P = 0.008）与总体生存时间较长相关。然而，多因素分析显示，这些因素均未达到统计学显著性。淋巴瘤、胸外恶性肿瘤、支气管源性肿瘤和胸腺肿瘤患者的平均生存时间分别为80.1个月（原文此处可能有误，结合前文推测应为8.01个月）、3.4个月、3.1个月和1.8个月。血管成形术与总体生存之间未显示出统计学上的显著关联。
据我们所知，本研究首次探讨了可能影响恶性SVCO生存结局的预后因素。我们发现，对于病因恶性的SVCO患者，高龄（50岁以上）、吸烟史和使用类固醇与不良结局在统计学上显著相关。潜在的原发性恶性病因也具有重要的预后意义。尽管医学取得了进展，但SVCO患者的预后仍然严峻。
