Wohlfarth Philipp, Staudinger Thomas, Sperr Wolfgang R, Bojic Andja, Robak Oliver, Hermann Alexander, Laczika Klaus, Carlström Alexander, Riss Katharina, Rabitsch Werner, Bojic Marija, Knoebl Paul, Locker Gottfried J, Obiditsch Maria, Fuhrmann Valentin, Schellongowski Peter
Department of Medicine I, Intensive Care Unit 13i2, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Ann Hematol. 2014 Oct;93(10):1629-36. doi: 10.1007/s00277-014-2141-x. Epub 2014 Jul 6.
Prognostic factors and outcomes of cancer patients with acute organ failure receiving chemotherapy (CT) in the intensive care unit (ICU) are still incompletely described. We therefore retrospectively studied all patients who received CT in any ICU of our institution between October 2006 and November 2013. Fifty-six patients with hematologic (n = 49; 87.5 %) or solid (n = 7; 12.5 %) malignancies, of which 20 (36 %) were diagnosed in the ICU, were analyzed [m/f ratio, 33:23; median age, 47 years (IQR 32 to 62); Charlson Comorbidity Index (CCI), 3 (2 to 5); Simplified Acute Physiology Score II (SAPS II), 50 (39 to 61)]. The main reasons for admission were acute respiratory failure, acute kidney failure, and septic shock. Mechanical ventilation and vasopressors were employed in 34 patients (61 %) respectively, hemofiltration in 22 (39 %), and extracorporeal life support in 7 (13 %). Twenty-seven patients (48 %) received their first CT in the ICU. Intention of therapy was cure in 46 patients (82 %). Tumor lysis syndrome (TLS) developed in 20 patients (36 %). ICU and hospital survival was 75 and 59 %. Hospital survivors were significantly younger; had lower CCI, SAPS II, and TLS risk scores; presented less often with septic shock; were less likely to develop TLS; and received vasopressors, hemofiltration, and thrombocyte transfusions in lower proportions. After discharge, 88 % continued CT and 69 % of 1-year survivors were in complete remission. Probability of 1- and 2-year survival was 41 and 38 %, respectively. Conclusively, administration of CT in selected ICU cancer patients was feasible and associated with considerable long-term survival as well as long-term disease-free survival.
重症监护病房（ICU）中接受化疗（CT）的急性器官衰竭癌症患者的预后因素和结局仍未得到充分描述。因此，我们回顾性研究了2006年10月至2013年11月期间在我院任何ICU接受CT治疗的所有患者。分析了56例血液系统（n = 49；87.5%）或实体瘤（n = 7；12.5%）恶性肿瘤患者，其中20例（36%）在ICU确诊 [男女比例为33:23；中位年龄47岁（IQR 32至62）；Charlson合并症指数（CCI）为3（2至5）；简化急性生理学评分II（SAPS II）为50（39至61）]。入院的主要原因是急性呼吸衰竭、急性肾衰竭和感染性休克。分别有34例患者（61%）使用了机械通气和血管升压药，22例（39%）进行了血液滤过，7例（13%）进行了体外生命支持。27例患者（48%）在ICU接受了首次CT治疗。46例患者（82%）的治疗目的是治愈。20例患者（36%）发生了肿瘤溶解综合征（TLS）。ICU生存率和医院生存率分别为75%和59%。医院幸存者明显更年轻；CCI、SAPS II和TLS风险评分更低；感染性休克的发生率更低；发生TLS的可能性更小；使用血管升压药、血液滤过和血小板输注的比例更低。出院后，88%的患者继续接受CT治疗，1年幸存者中有69%完全缓解。1年和2年生存率分别为41%和38%。总之，在选定的ICU癌症患者中进行CT治疗是可行的，并且与相当可观的长期生存率以及长期无病生存率相关。
