Heo Su Jin, Kim Gyuri, Lee Choong-Kun, Chung Kyung Soo, Choi Hye Jin, Sohn Joohyuk, Lee Soohyeon
Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
Support Care Cancer. 2015 Jun;23(6):1647-55. doi: 10.1007/s00520-014-2519-2. Epub 2014 Nov 23.
Intensive care unit (ICU) admission of advanced cancer patients is controversial because it is associated with poor short-term prognosis. However, ICU admission of these patients might also result in administration of specific anticancer treatments and evaluation of tumor characteristics, which could influence long-term outcomes. Herein, we investigate whether there is a relationship between ICU admission and long-term outcomes for advanced cancer patients.
We analyzed 116 advanced cancer patients who were admitted to the ICU at Severance Hospital, Yonsei University, between January 2010 and December 2012. We excluded palliative care-only patients. We analyzed demographic, clinical, and survival data of patients admitted to the ICU, and we identified patient characteristics that were measured upon presentation to ICU to determine whether any of these are prognostic or predictive factors of short- or long-term survival.
The median age of our study sample was 64 years. Sixty-nine (59.5 %) patients were male. Lung, breast, and stomach were the most common primary tumor sites. Eighty-seven (75 %) patients had received active anticancer treatment within the past 30 days. The main cause of ICU admission was acute respiratory failure (73 %); thus, 102 (87.9 %) patients were managed with conventional mechanical ventilation, 99 (85.3 %) patients in vasopressor and 31 (26.7 %) patients received continuous renal replacement therapy (CRRT). Twenty-four (20.7 %) patients were in postresuscitation status before ICU admission. The ICU, hospital, and 6-month survival rates were 51.7, 31.0, and 15.5 %, respectively. APACHE II score (HR 2.86, 95 % CI 1.00-8.15, P < 0.050) and need for CRRT (HR 2.14, 95 % CI 1.24-3.70, P < 0.007) were associated with ICU mortality in a Cox-regression model. Eastern Cooperative Oncology Group (ECOG) performance status (HR 1.64, 95 % CI 1.03-2.62, P < 0.010) was associated with poor prognosis, and controlled disease status (HR 0.372, 95 % CI 0.21-0.67, P < 0.001) was found to be a good prognostic factor for 6-month survival after ICU admission.
Clinical factors associated with acute, critical status upon ICU admission, such as APACHE II score and need of CRRT, were associated with a higher risk of ICU mortality and short-term mortality than factors directly associated with the patient's cancer. To understand the relationship between ICU admission and long-term survival, however, we have to apply more comprehensive approach that also considers tumor characteristics and disease control status.
晚期癌症患者入住重症监护病房（ICU）存在争议，因为这与短期预后不良相关。然而，这些患者入住ICU也可能导致给予特定的抗癌治疗并评估肿瘤特征，这可能会影响长期预后。在此，我们研究晚期癌症患者入住ICU与长期预后之间是否存在关联。
我们分析了2010年1月至2012年12月期间在延世大学Severance医院入住ICU的116例晚期癌症患者。我们排除了仅接受姑息治疗的患者。我们分析了入住ICU患者的人口统计学、临床和生存数据，并确定了患者入住ICU时测量的特征，以确定这些特征是否为短期或长期生存的预后或预测因素。
我们研究样本的中位年龄为64岁。69例（59.5%）患者为男性。肺癌、乳腺癌和胃癌是最常见的原发肿瘤部位。87例（75%）患者在过去30天内接受了积极的抗癌治疗。入住ICU的主要原因是急性呼吸衰竭（73%）；因此，102例（87.9%）患者接受了传统机械通气，99例（85.3%）患者使用了血管活性药物，31例（26.7%）患者接受了持续肾脏替代治疗（CRRT）。24例（20.7%）患者在入住ICU前处于复苏后状态。ICU、医院和6个月生存率分别为51.7%、31.0%和15.5%。在Cox回归模型中，急性生理与慢性健康状况评分系统（APACHE II）评分（HR 2.86，95%CI 1.00 - 8.15，P < 0.050）和需要CRRT（HR 2.14，95%CI 1.24 - 3.70，P < 0.007）与ICU死亡率相关。东部肿瘤协作组（ECOG）体能状态（HR 1.64，95%CI 1.03 - 2.62，P < 0.010）与预后不良相关，而疾病控制状态（HR 0.372，95%CI 0.21 - 0.67，P < 0.001）被发现是入住ICU后6个月生存的良好预后因素。
与入住ICU时急性、危急状态相关的临床因素，如APACHE II评分和需要CRRT，与ICU死亡率和短期死亡率的风险高于与患者癌症直接相关的因素。然而，为了理解入住ICU与长期生存之间的关系，我们必须采用更全面的方法，同时考虑肿瘤特征和疾病控制状态。
