Post-Graduation Program, Instituto Nacional de Câncer, Rio de Janeiro; Department of Clinical Research, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
Thoracic Oncology Unit.
Ann Oncol. 2014 Sep;25(9):1829-1835. doi: 10.1093/annonc/mdu234. Epub 2014 Jun 20.
Detailed information about lung cancer patients requiring admission to intensive care units (ICUs) is mostly restricted to single-center studies. Our aim was to evaluate the clinical characteristics and outcomes of lung cancer patients admitted to ICUs.
Prospective multicenter study in 449 patients with lung cancer (small cell, n = 55; non-small cell, n = 394) admitted to 22 ICUs in six countries in Europe and South America during 2011. Multivariate Cox proportional hazards frailty models were built to identify characteristics associated with 30-day and 6-month mortality.
Most of the patients (71%) had newly diagnosed cancer. Cancer-related complications occurred in 56% of patients; the most common was tumoral airway involvement (26%). Ventilatory support was required in 53% of patients. Overall hospital, 30-day, and 6-month mortality rates were 39%, 41%, and 55%, respectively. After adjustment for type of admission and early treatment-limitation decisions, determinants of mortality were organ dysfunction severity, poor performance status (PS), recurrent/progressive cancer, and cancer-related complications. Mortality rates were far lower in the patient subset with nonrecurrent/progressive cancer and a good PS, even those with sepsis, multiple organ dysfunctions, and need for ventilatory support. Mortality was also lower in high-volume centers. Poor PS predicted failure to receive the initially planned cancer treatment after hospital discharge.
ICU admission was associated with meaningful survival in lung cancer patients with good PS and non-recurrent/progressive disease. Conversely, mortality rates were very high in patients not fit for anticancer treatment and poor PS. In this subgroup, palliative care may be the best option.
关于需要入住重症监护病房（ICU）的肺癌患者的详细信息大多仅限于单中心研究。我们的目的是评估入住 ICU 的肺癌患者的临床特征和结局。
这是一项在欧洲和南美洲六个国家的 22 个 ICU 中，于 2011 年期间入组的 449 例肺癌（小细胞肺癌，n=55；非小细胞肺癌，n=394）患者的前瞻性多中心研究。采用多变量 Cox 比例风险脆弱性模型来确定与 30 天和 6 个月死亡率相关的特征。
大多数患者（71%）为新发癌症。56%的患者出现与癌症相关的并发症；最常见的是肿瘤气道受累（26%）。53%的患者需要通气支持。总体住院、30 天和 6 个月的死亡率分别为 39%、41%和 55%。在调整入院类型和早期治疗限制决策后，死亡率的决定因素为器官功能障碍严重程度、较差的表现状态（PS）、复发性/进展性癌症和与癌症相关的并发症。对于非复发性/进展性癌症且 PS 良好的患者亚组，死亡率要低得多，即使他们患有败血症、多器官功能障碍和需要通气支持也是如此。高容量中心的死亡率也较低。较差的 PS 预测出院后无法接受最初计划的癌症治疗。
对于 PS 良好且非复发性/进展性疾病的肺癌患者，入住 ICU 与有意义的生存相关。相反，不适合抗癌治疗和 PS 较差的患者的死亡率非常高。在这亚组中，姑息治疗可能是最佳选择。
