Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
Palliat Support Care. 2019 Dec;17(6):677-685. doi: 10.1017/S1478951519000051.
Percutaneous tunneled drainage catheter (PTDC) placement is a palliative alternative to serial paracenteses in patients with end-stage cancer and refractory ascites. The impact of PTDC on quality of life (QoL) and long-term outcomes has not been prospectively described. The objective was to evaluate changes in QoL after PTDC.
Eligible adult patients with end-stage cancer undergoing PTDC placement for refractory ascites completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and McGill Quality of Life instruments before PTDC placement and at 2 to 7 days and 2 to 4 weeks after PTDC. Catheter function, complications, and laboratory values were assessed. Analysis of QoL data was evaluated with a stratified Wilcoxon signed-rank test.
Fifty patients enrolled. Survey completion ranged from 65% to 100% (median 88%) across timepoints. All patients had a Tenckhoff catheter, with 98% technical success. Median survival after PTDC was 38 days (95% confidence interval = 32, 57 days). European Organization for Research and Treatment of Cancer scores showed improvement in global QoL (p = 0.03) at 1 week postprocedure (PP). Significant symptom improvement was reported for fatigue, nausea/vomiting, pain, dyspnea, insomnia, and appetite at 1 week PP and was sustained at 3 weeks PP for dyspnea (p < 0.01), insomnia (p < 0.01), and appetite loss (p = 0.03). McGill Quality of Life demonstrated overall QoL improvement at 1 (p = 0.03) and 3 weeks (p = 0.04) PP. Decline in sodium and albumin values pre- and post-PTDC slowed significantly (albumin slope -0.43 to -0.26, p = 0.055; sodium slope -2.50 to 1.31, p = 0.04). Creatinine values increased at an accelerated pace post-PTDC (0.040 to 0.21, p < 0.01). Thirty-eight catheter-related complications occurred in 24 of 45 patients (53%).
QoL and symptoms improved after PTDC placement for refractory ascites in patients with end-stage malignancy. Decline in sodium and albumin values slowed postplacement. This study supports the use of a PTDC for palliation of refractory ascites in cancer patients.
经皮隧道引流导管（PTDC）的放置是终末期癌症合并难治性腹水患者进行多次腹腔穿刺放液的一种姑息性替代疗法。然而，PTDC 对生活质量（QoL）和长期预后的影响尚未得到前瞻性描述。本研究旨在评估 PTDC 后 QoL 的变化。
纳入符合条件的行 PTDC 治疗难治性腹水的成年终末期癌症患者，在 PTDC 放置前以及放置后 2-7 天和 2-4 周时，分别使用欧洲癌症研究与治疗组织生活质量问卷和 McGill 生活质量量表进行评估。同时评估导管功能、并发症和实验室值。采用分层 Wilcoxon 符号秩检验分析 QoL 数据。
共纳入 50 例患者。各时间点的调查完成率为 65%至 100%（中位数 88%）。所有患者均使用 Tenckhoff 导管，技术成功率为 98%。PTDC 后中位生存时间为 38 天（95%置信区间：32，57 天）。欧洲癌症研究与治疗组织评分显示，术后 1 周时总体 QoL 得到改善（p = 0.03）。术后 1 周时，患者报告疲劳、恶心/呕吐、疼痛、呼吸困难、失眠和食欲等症状显著改善，3 周时呼吸困难（p < 0.01）、失眠（p < 0.01）和食欲丧失（p = 0.03）仍持续改善。McGill 生活质量量表显示，术后 1 周（p = 0.03）和 3 周（p = 0.04）时总体 QoL 得到改善。PTDC 前后钠和白蛋白值的下降速度显著减慢（白蛋白斜率 -0.43 至 -0.26，p = 0.055；钠斜率 -2.50 至 1.31，p = 0.04）。PTDC 后肌酐值加速升高（0.040 至 0.21，p < 0.01）。45 例患者中有 24 例（53%）发生了 38 例与导管相关的并发症。
难治性腹水的终末期恶性肿瘤患者行 PTDC 治疗后，QoL 和症状得到改善。PTDC 后，钠和白蛋白值的下降速度减慢。本研究支持将 PTDC 用于癌症患者难治性腹水的姑息治疗。
