Divisions of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Songnam-si, Gyeonggi-do, 463-707, Republic of Korea.
Med Oncol. 2014 Mar;31(3):847. doi: 10.1007/s12032-014-0847-1. Epub 2014 Jan 22.
Critical care for advanced lung cancer patients is still controversial, and the appropriate method for the selection of patients who may benefit from intensive care unit (ICU) care is not clearly defined. We retrospectively reviewed the medical records of stage IIIB-IV lung cancer patients admitted to the medical ICU of a university hospital in Korea between 2003 and 2011. Of 95 patients, 64 (67%) had Eastern Cooperative Oncology Group (ECOG) performance status (PS)≥2, and 79 (84%) had non-small-cell lung cancer. In total, 28 patients (30%) were newly diagnosed or were receiving first-line treatment, and 22 (23%) were refractory or bedridden. Mechanical ventilation was required in 85 patients (90%), and ICU mortality and hospital mortality were 57 and 78%, respectively. According to a multivariate analysis, a PaO2/FiO2 ratio<150 [odds ratio (OR)=5.51, 95% confidence interval (CI) 2.10-14.48, p=0.001] was independently associated with ICU mortality, and an ECOG PS≥2 (OR=9.53, 95% CI 2.03-44.85, p=0.004) and a need for vasoactive agents (OR=6.94, 95% CI 1.61-29.84, p=0.009) were independently associated with hospital mortality. Refractory or bedridden patients (n=22) showed significantly poorer overall survival (11.0 vs. 29.0 days, p=0.005). Among 21 patients who were discharged from the hospital, 11 (52%) received further chemotherapy. Certain advanced lung cancer patients may benefit from ICU management. However, refractory patients and patients with a poor PS do not seem to benefit from ICU care. Oncologists should try to discuss palliative care and end-of-life issues in advance to avoid futile care.
晚期肺癌患者的重症监护仍然存在争议，对于可能从重症监护病房（ICU）治疗中获益的患者，选择合适的方法尚未明确界定。我们回顾性分析了 2003 年至 2011 年期间在韩国一所大学医院的内科 ICU 住院的 IIIB-IV 期肺癌患者的病历。95 例患者中，64 例（67%）ECOG 表现状态（PS）≥2，79 例（84%）为非小细胞肺癌。共有 28 例（30%）为初诊或接受一线治疗，22 例（23%）为难治性或卧床不起。85 例患者（90%）需要机械通气，ICU 死亡率和医院死亡率分别为 57%和 78%。多变量分析显示，PaO2/FiO2 比值<150（比值比（OR）=5.51，95%置信区间（CI）2.10-14.48，p=0.001）与 ICU 死亡率独立相关，ECOG PS≥2（OR=9.53，95%CI 2.03-44.85，p=0.004）和需要血管活性药物（OR=6.94，95%CI 1.61-29.84，p=0.009）与医院死亡率独立相关。难治性或卧床不起的患者（n=22）的总生存情况明显较差（11.0 天 vs. 29.0 天，p=0.005）。在 21 例出院的患者中，有 11 例（52%）接受了进一步的化疗。某些晚期肺癌患者可能受益于 ICU 管理。然而，难治性患者和 PS 差的患者似乎不能从 ICU 护理中获益。肿瘤学家应尽早讨论姑息治疗和临终问题，以避免无益的护理。
