Blakely Andrew M, Heffernan Daithi S, McPhillips Jane, Cioffi William G, Miner Thomas J
Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
J Surg Oncol. 2014 Nov;110(6):651-5. doi: 10.1002/jso.23682. Epub 2014 Jun 25.
Optimal surgical decision-making and informed consent for palliative procedures is limited by a lack of appropriate outcomes data. Elevated C-reactive protein (CRP) may help guide patient selection for palliative surgery.
Procedures to palliate symptoms of advanced cancer were identified from a prospective palliative surgery database. Patients with a recorded preoperative serum CRP were identified and observed for at least 180 days or until death.
Fifty patients were identified who underwent an elective palliative procedure from July 2006 to June 2012. Presenting symptoms included gastrointestinal obstruction (40%), tumor-related pain (38%) or bleeding (12%), and other (10%). Symptom improvement was documented for 37 patients (74%). Palliative procedures were associated with 30-day postoperative morbidity (42%) and mortality (10%). CRP (range 1-144 mg/L, median 9.7 mg/L) was elevated in 27 patients (54%) and was independently associated with developing a major complication (P = 0.005) and decreased overall survival (166 vs. 659 days, P < 0.0001).
Patients with advanced cancer can be afforded symptom improvement and the opportunity for improved quality of life following palliative procedures. Elevated preoperative CRP may help identify patients who are less likely to realize the benefits of palliative operations.
由于缺乏合适的预后数据，姑息治疗手术的最佳决策制定及知情同意受到限制。C反应蛋白（CRP）升高可能有助于指导姑息性手术的患者选择。
从一个前瞻性姑息性手术数据库中识别出缓解晚期癌症症状的手术。识别出术前血清CRP有记录的患者，并对其进行至少180天的观察或直至死亡。
确定了50例在2006年7月至2012年6月期间接受择期姑息性手术的患者。主要症状包括胃肠道梗阻（40%）、肿瘤相关疼痛（38%）或出血（12%）以及其他（10%）。记录到37例患者（74%）症状改善。姑息性手术与术后30天发病率（42%）和死亡率（10%）相关。27例患者（54%）CRP升高（范围1 - 144mg/L，中位数9.7mg/L），且与发生严重并发症独立相关（P = 0.005）以及总体生存期缩短相关（166天对659天，P < 0.0001）。
晚期癌症患者在接受姑息性手术后症状可得到改善，生活质量有提高的机会。术前CRP升高可能有助于识别不太可能从姑息性手术中获益的患者。
