Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.
Department of Radiology, Saint-Louis University Hospital, AP-HP, Paris, France.
Support Care Cancer. 2018 Feb;26(2):521-528. doi: 10.1007/s00520-017-3860-z. Epub 2017 Aug 24.
The purpose of this study is to describe the management and outcome of critically ill cancer patients with Superior Vena Cava Syndrome (SVCS).
All cancer patients admitted to the medical intensive care unit (ICU) of the Saint-Louis University Hospital for a SVCS between January 2004 and December 2016 were included.
Of the 50 patients included in the study, obstruction of the superior vena cava was partial in two-thirds of the cases and complete in one-third. Pleural effusion was reported in two-thirds of the patients, pulmonary atelectasis in 16 (32%), and pulmonary embolism in five (10%). Computed tomography of the chest showed upper airway compression in 18 (36%) cases, while echocardiography revealed 22 (44%) pericardial effusions. The causes of SVCS were diagnosed one (0-3) day after ICU admission, using interventional radiology procedures in 70% of the cases. Thirty (60%) patients had hematological malignancies, and 20 (40%) had solid tumors. Fifteen (30%) patients required invasive mechanical ventilation, seven (14%) received vasopressors, and renal replacement therapy was implemented in three (6%). ICU, in-hospital, and 6-month mortality rates were 20, 26, and 48%, respectively. The cause of SVCS was the only factor independently associated with day 180 mortality by multivariate analysis. Patients with hematological malignancies had a lower mortality than those with solid tumors (27 versus 80%) (odds ratio 0.12, 95% confidence interval (0.02-0.60), p < 0.01).
Airway obstruction and pleural and pericardial effusions contributed to the unstable condition of cancer patients with SVCS. The vital prognosis of SVCS was mainly related to the underlying diagnosis.
本研究旨在描述伴有上腔静脉综合征（SVCS）的危重症癌症患者的管理和结局。
纳入 2004 年 1 月至 2016 年 12 月期间在圣路易斯大学医院内科重症监护病房（ICU）因 SVCS 住院的所有癌症患者。
在纳入研究的 50 例患者中，上腔静脉阻塞分别有三分之二为不完全阻塞和三分之一为完全阻塞。三分之二的患者出现胸腔积液，16 例（32%）出现肺不张，5 例（10%）出现肺栓塞。胸部 CT 显示 18 例（36%）存在上气道压迫，超声心动图显示 22 例（44%）存在心包积液。SVCS 的病因在 ICU 入院后 1-3 天通过介入放射学程序确诊，70%的患者采用该方法。30 例（60%）患者患有血液系统恶性肿瘤，20 例（40%）患有实体瘤。15 例（30%）患者需要有创机械通气，7 例（14%）需要血管加压药，3 例（6%）需要肾脏替代治疗。ICU 死亡率、院内死亡率和 6 个月死亡率分别为 20%、26%和 48%。多因素分析显示，SVCS 的病因是与 180 天死亡率相关的唯一因素。与实体瘤患者相比，血液系统恶性肿瘤患者的死亡率较低（27%比 80%）（比值比 0.12，95%置信区间 0.02-0.60，p<0.01）。
气道阻塞和胸腔及心包积液导致 SVCS 癌症患者病情不稳定。SVCS 的生存预后主要与基础诊断有关。
