Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
Tumori. 2021 Feb;107(1):17-25. doi: 10.1177/0300891620931172. Epub 2020 Jun 12.
Although many reports have analyzed the outcomes of central venous catheters (CVCs) in oncologic and oncohematologic patients, current guidelines do not routinely recommend a specific type of CVC over the other.
We retrospectively evaluated the outcomes of 178 patients with CVCs referred to an Italian specialized cancer center between January 2016 and December 2018. The analysis compares midterm peripherally inserted central venous catheters (PICCs) with long-term centrally inserted catheters, including totally implanted ports and tunneled catheters with central insertion (tCVCs).
A total of 130 PICCs (73%) and 48 tCVCs (27%) were analyzed. The overall complication rate was significantly increased in the PICC cohort compared to the tCVC cohort (43.1% vs 25%, respectively; = 0.037), leading to complication-related device removal in 30.8% of PICCs vs 12.5% of tCVCs ( = 0.013). No significant differences in terms of catheter-related thromboses ( = 0.676) or catheter-related infections ( = 0.140) were detected. Nonthrombotic obstructions were significantly higher in the PICC group compared to the tCVC cohort ( = 0.006). Overall complication-free survival was significantly longer for tCVCs compared to PICCs (hazard ratio [HR], 0.262; 95% confidence interval [CI], 0.128-0.536; < 0.0001), as well as obstruction-free survival (HR, 0.082; 95% CI, 0.018-0.372; < 0.0001). In multivariable analysis, the type of CVC was independently correlated with the occurrence of any complication (HR, 0.273; 95% CI, 0.135-0.553; < 0.0001).
This Italian real-world experience suggests that PICCs are associated with a higher risk of overall complications compared with tCVCs. Catheter choice in oncologic patients should be guided by treatment type and duration, risk-benefit assessment, patient preferences, and compliance.
虽然许多报告分析了中心静脉导管（CVC）在肿瘤和血液肿瘤患者中的结局，但目前的指南并未常规推荐一种特定类型的 CVC 优于另一种。
我们回顾性评估了 178 例于 2016 年 1 月至 2018 年 12 月在意大利专门癌症中心就诊的 CVC 患者的结局。该分析比较了中期外周插入的中心静脉导管（PICC）与长期中心插入导管，包括完全植入式端口和带中心插入的隧道导管（tCVC）。
共分析了 130 例 PICC（73%）和 48 例 tCVC（27%）。与 tCVC 组相比，PICC 组的总体并发症发生率显著增加（分别为 43.1%和 25%；= 0.037），导致 30.8%的 PICC 组和 12.5%的 tCVC 组因并发症而需要移除设备（= 0.013）。导管相关血栓形成（= 0.676）或导管相关感染（= 0.140）方面无显著差异。非血栓性阻塞在 PICC 组明显高于 tCVC 组（= 0.006）。与 PICC 组相比，tCVC 组的总体无并发症生存时间显著更长（风险比[HR]，0.262；95%置信区间[CI]，0.128-0.536；<0.0001），无阻塞生存时间（HR，0.082；95%CI，0.018-0.372；<0.0001）。多变量分析显示，CVC 类型与任何并发症的发生独立相关（HR，0.273；95%CI，0.135-0.553；<0.0001）。
意大利的真实世界经验表明，与 tCVC 相比，PICC 与总体并发症风险增加相关。肿瘤患者的导管选择应根据治疗类型和持续时间、风险效益评估、患者偏好和依从性来指导。
