Respiratory Medicine, Plymouth Hospitals NHS Trust, Plymouth, UK.
Interventional Respiratory Unit, Galway University Hospitals, Galway, Ireland.
BMJ Open Respir Res. 2019 Sep 24;6(1):e000429. doi: 10.1136/bmjresp-2019-000429. eCollection 2019.
Central airway obstruction (CAO) is a life-threatening complication of lung cancer. The prevalence of CAO in lung cancer patients is unknown. We audited CAO burden to inform our local cancer service.
This is a cohort review of all new lung cancer diagnoses between 1 November 2014 and 30 November 2015. CAO was defined by CT appearance. CT scans and routine patient records were followed up to 30 November 2018 to determine the prevalence of CAO at diagnosis; the characteristics of patients with prevalent CAO; mortality (using survival analysis); and incident CAO over follow-up.
Of 342 new lung cancer diagnoses, CAO prevalence was 13% (95% CI 10% to 17%; n=45/342). Dedicated CT scan review identified missed CAO in 14/45 (31%) cases. In patients with prevalent CAO, 27/44 (61%) had a performance status of ≤2, 23/45 (51%) were diagnosed during an acute admission and 36/44 (82%) reported symptoms. Treatments were offered to 32/45 (71%); therapeutic bronchoscopy was performed in only 8/31 (26%) eligible patients. Median survival of patients with prevalent CAO was 94 (IQR 33-274) days. Multivariate analysis, adjusting for age, gender and disease stage, found CAO on index CT scan was independently associated with an increased hazard of death (adjusted HR 1.78 (95% CI 1.27 to 2.48); p=0.001). In total, 15/297 (5%) developed CAO during follow-up (median onset 340 (IQR 114-551) days). Over the audit period, 60/342 (18%; 95% CI 14% to 22%) had or developed CAO.
This is the first description of CAO prevalence in 40 years. Patients with prevalent CAO had a higher mortality. Our data provide a benchmark for service planning.
中央气道阻塞（CAO）是肺癌的一种危及生命的并发症。肺癌患者中 CAO 的患病率尚不清楚。我们对 CAO 负担进行了审核，为我们当地的癌症服务提供信息。
这是一项对 2014 年 11 月 1 日至 2015 年 11 月 30 日期间所有新诊断的肺癌病例的队列研究。CAO 通过 CT 表现定义。对 CT 扫描和常规患者记录进行随访，直至 2018 年 11 月 30 日，以确定诊断时 CAO 的患病率；患有流行 CAO 的患者的特征；死亡率（使用生存分析）；以及随时间推移发生的 CAO。
在 342 例新诊断的肺癌患者中，CAO 患病率为 13%（95%CI 10%至 17%；n=45/342）。专门的 CT 扫描审查发现，45 例中有 14 例（31%）漏诊 CAO。在患有流行 CAO 的患者中，27/44（61%）的表现状态为≤2，23/45（51%）在急性入院期间诊断，36/44（82%）报告有症状。向 32/45（71%）名患者提供了治疗；仅对 8/31（26%）符合条件的患者进行了治疗性支气管镜检查。有流行 CAO 的患者的中位生存时间为 94（IQR 33-274）天。多变量分析，调整年龄、性别和疾病分期后，发现指数 CT 扫描上的 CAO 与死亡风险增加独立相关（调整 HR 1.78（95%CI 1.27 至 2.48）；p=0.001）。总共有 15/297（5%）名患者在随访期间发生 CAO（中位发病时间 340（IQR 114-551）天）。在审核期间，60/342（18%；95%CI 14%至 22%）名患者发生或发展了 CAO。
这是 40 年来首次描述 CAO 的患病率。患有流行 CAO 的患者死亡率更高。我们的数据为服务规划提供了基准。
