Chen Yen-Fu, Lin Jou-Wei, Ho Chao-Chi, Yang Ching-Yao, Chang Chia-Hao, Huang Tao-Min, Chen Chung-Yu, Chen Kuan-Yu, Shih Jin-Yuan, Yu Chong-Jen
Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, No.579, Sec. 2, Yunlin Rd., Douliou City, Yunlin County 640, Taiwan (R.O.C.).
Department of Internal Medicine, National Taiwan University Hospital, No.7, Zhongshan South Road, Taipei 100, Taiwan (ROC).
J Cancer. 2017 Jul 5;8(11):1995-2003. doi: 10.7150/jca.18178. eCollection 2017.
Therapy outcomes for newly diagnosed, critically ill lung cancer patients have seldom been evaluated. This study evaluated therapy outcomes for treatment-naïve lung cancer patients in the intensive care unit (ICU). Patients were excluded if they had previously received lung cancer treatment, such as systemic chemotherapy, targeted therapy, radiotherapy, or surgical lung resection before ICU admission. The therapeutic strategies for the treatment-naïve patients were determined while they were in the ICU. The patients' demographic data, clinical outcomes, and treatment-related toxicities were analyzed. Newly diagnosed lung cancer patients (n = 72) who did not receive any anticancer treatment before ICU admission were included. Most patients had locally advanced disease, and 61 (84.7%) required intensive care due to cancer-related events. In the ICU, 24 (33.3%) patients received chemotherapy, 24 (33.3%) received epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy and 24 (33.3%) received best supportive care (BSC). Patients receiving chemotherapy or EGFR-TKIs in the ICU demonstrated better ICU (p = 0.011) and in-hospital (p = 0.034) survival than those receiving BSC only. Among patients requiring mechanical ventilation, those receiving chemotherapy had higher weaning rates than those receiving EGFR-TKIs or BSC (p = 0.002). In multivariate analysis, receipt of chemotherapy (hazard ratio [HR], 0.443; p = 0.083) and mechanical ventilation (HR, 0.270; p = 0.022) were significantly associated with longer ICU survival after adjusting for clinical factors. Anticancer therapy in the ICU might provide better short-term ICU survival for treatment-naïve, critically ill lung cancer patients.
新诊断的重症肺癌患者的治疗结果很少得到评估。本研究评估了重症监护病房（ICU）中未接受过治疗的肺癌患者的治疗结果。如果患者在入住ICU之前曾接受过肺癌治疗，如全身化疗、靶向治疗、放疗或肺手术切除，则被排除。在ICU期间确定未接受过治疗患者的治疗策略。分析了患者的人口统计学数据、临床结果和治疗相关毒性。纳入了72例在入住ICU之前未接受过任何抗癌治疗的新诊断肺癌患者。大多数患者患有局部晚期疾病，61例（84.7%）因癌症相关事件需要重症监护。在ICU中，24例（33.3%）患者接受了化疗，24例（33.3%）接受了表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）治疗，24例（33.3%）接受了最佳支持治疗（BSC）。在ICU中接受化疗或EGFR-TKI治疗的患者比仅接受BSC治疗的患者表现出更好的ICU生存率（p = 0.011）和住院生存率（p = 0.034）。在需要机械通气的患者中，接受化疗的患者脱机成功率高于接受EGFR-TKI或BSC治疗的患者（p = 0.002）。在多变量分析中，在调整临床因素后，接受化疗（风险比[HR]，0.443；p = 0.083）和机械通气（HR，0.270；p = 0.022）与更长的ICU生存时间显著相关。在ICU中进行抗癌治疗可能为未接受过治疗的重症肺癌患者提供更好的短期ICU生存。
