Bosscher Marianne R F, Bastiaannet Esther, van Leeuwen Barbara L, Hoekstra Harald J
Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Surgery, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
Ann Surg Oncol. 2016 Jun;23(6):1803-14. doi: 10.1245/s10434-015-4939-8. Epub 2015 Nov 9.
The clinical outcome of patients with oncologic emergencies is often poor and mortality is high. It is important to determine which patients may benefit from invasive treatment, and for whom conservative treatment and/or palliative care would be appropriate. In this study, prognostic factors for clinical outcome are identified in order to facilitate the decision-making process for patients with surgical oncologic emergencies.
This was a prospective registration study for patients over 18 years of age, who were consulted for surgical oncologic emergencies between November 2013 and April 2014. Multiple variables were registered upon emergency consultation, and the follow-up period was 90 days. Multivariate logistic regression analysis was performed to identify factors associated with 30- and 90-day mortality.
During the study period, 207 patients experienced surgical oncologic emergencies-101 (48.8 %) men and 106 (51.2 %) women, with a median age of 64 years (range 19-92). The 30-day mortality was 12.6 % and 90-day mortality was 21.7 %. Factors significantly associated with 30-day mortality were palliative intent of cancer treatment prior to emergency consultation (p = 0.006), Eastern Cooperative Oncology Group performance score (ECOG-PS) >0 (p for trend: p = 0.03), and raised lactate dehydrogenase (LDH) (p < 0.001). Additional factors associated with 90-day mortality were low handgrip strength (HGS) (p = 0.01) and low albumin (p = 0.002).
Defining the intent of prior cancer treatment and the ECOG-PS are of prognostic value when deciding on treatment for patients with surgical oncologic emergencies. Additional measurements of HGS, LDH, and albumin levels can serve as objective parameters to support the clinical assessment of individual prognosis.
肿瘤急症患者的临床结局通常较差，死亡率较高。确定哪些患者可能从侵入性治疗中获益，以及哪些患者适合保守治疗和/或姑息治疗非常重要。在本研究中，确定临床结局的预后因素，以促进外科肿瘤急症患者的决策过程。
这是一项针对18岁以上患者的前瞻性登记研究，这些患者在2013年11月至2014年4月期间因外科肿瘤急症前来咨询。在紧急咨询时记录多个变量，随访期为90天。进行多变量逻辑回归分析，以确定与30天和90天死亡率相关的因素。
在研究期间，207例患者经历了外科肿瘤急症，其中男性101例（48.8%），女性106例（51.2%），中位年龄为64岁（范围19 - 92岁）。30天死亡率为12.6%，90天死亡率为21.7%。与30天死亡率显著相关的因素是紧急咨询前癌症治疗的姑息意图（p = 0.006）、东部肿瘤协作组体能状态评分（ECOG-PS）>0（趋势p值：p = 0.03）以及乳酸脱氢酶（LDH）升高（p < 0.001）。与90天死亡率相关的其他因素是握力（HGS）低（p = 0.01）和白蛋白低（p = 0.002）。
在决定外科肿瘤急症患者的治疗方案时，明确先前癌症治疗的意图和ECOG-PS具有预后价值。额外测量HGS、LDH和白蛋白水平可作为客观参数，以支持对个体预后的临床评估。
