Mori Masanori, Shirado Akemi Naito, Morita Tatsuya, Okamoto Kenichiro, Matsuda Yoshinobu, Matsumoto Yoshihisa, Yamada Hirohide, Sakurai Hiroki, Aruga Etsuko, Kaneishi Keisuke, Watanabe Hiroaki, Yamaguchi Takashi, Odagiri Takuya, Hiramoto Shuji, Kohara Hiroyuki, Matsuo Naoki, Katayama Hideki, Nishi Tomohiro, Matsui Takashi, Iwase Satoru
Seirei Mikatahara General Hospital, 3453, Mikatahara-Cho, Kita-Ku, Hamamatsu, Shizuoka, 433-8558, Japan.
Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka, 433-8558, Japan.
Support Care Cancer. 2017 Apr;25(4):1169-1181. doi: 10.1007/s00520-016-3507-5. Epub 2016 Nov 29.
Although corticosteroids can relieve dyspnea in advanced cancer patients, factors predicting the response remain unknown. We aimed to explore potential factors predicting the response to corticosteroids for dyspnea in advanced cancer patients.
In this preliminary multicenter prospective observational study, we included patients who had metastatic or locally advanced cancer, were receiving specialized palliative care services, and had a dyspnea intensity of ≥3 on a 0-10 Numerical Rating Scale (NRS) (worst during the last 24 h). The primary endpoint was NRS of dyspnea on day 3 after the administration of corticosteroids. Univariate/multivariate analyses were conducted to identify factors predicting ≥1-point reduction in NRS.
Of 74 patients who received corticosteroids, 50 (68%) showed ≥1-point reduction in dyspnea NRS. Factors that significantly predicted the response were an age of 70 years or older (82 vs. 53%, p = 0.008), absence of liver metastases (77 vs. 46%, p = 0.001), Palliative Prognostic Index (PPI) ≤ 6 (90 vs. 61%, p = 0.041), presence of pleuritis carcinomatosa with a small collection of pleural effusions (84 vs. 55%, p = 0.011), presence of audible wheezes (94 vs. 60%, p = 0.014), and baseline dyspnea NRS ≥7 (76% vs. 52%, p = 0.041). In a multivariate analysis, factors predicting response included PPI <6 (odds ratio (OR), 36.2; p = 0.021), baseline dyspnea NRS (worst) ≥7 (OR, 6.6; p = 0.036), and absence of liver metastases (OR, 0.19; p = 0.029) or ascites/liver enlargement (OR, 0.13; p = 0.050).
The patient characteristics, etiologies of dyspnea, and clinical manifestations may predict responses to corticosteroids for dyspnea. Larger prospective studies are promising to confirm our findings.
尽管皮质类固醇可缓解晚期癌症患者的呼吸困难，但预测其反应的因素仍不清楚。我们旨在探索预测晚期癌症患者对皮质类固醇治疗呼吸困难反应的潜在因素。
在这项初步的多中心前瞻性观察研究中，我们纳入了患有转移性或局部晚期癌症、正在接受专科姑息治疗服务且在0-10数字评定量表（NRS）上呼吸困难强度≥3（过去24小时内最严重时）的患者。主要终点是皮质类固醇给药后第3天的呼吸困难NRS。进行单因素/多因素分析以确定预测NRS降低≥1分的因素。
在74例接受皮质类固醇治疗的患者中，50例（68%）的呼吸困难NRS降低≥1分。显著预测反应的因素包括年龄70岁或以上（82%对53%，p = 0.008）、无肝转移（77%对46%，p = 0.001）、姑息预后指数（PPI）≤6（90%对61%，p = 0.041）、存在伴有少量胸腔积液的癌性胸膜炎（84%对55%，p = 0.011）、存在可闻及的哮鸣音（94%对60%，p = 0.014）以及基线呼吸困难NRS≥7（76%对52%，p = 0.041）。在多因素分析中，预测反应的因素包括PPI<6（比值比（OR），36.2；p = 0.021）、基线呼吸困难NRS（最严重时）≥7（OR，6.6；p = 0.036）以及无肝转移（OR，0.19；p = 0.029）或腹水/肝脏肿大（OR，0.13；p = 0.050）。
患者特征、呼吸困难病因及临床表现可能预测对皮质类固醇治疗呼吸困难的反应。更大规模的前瞻性研究有望证实我们的发现。
