Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Department of Internal Medicine, Tainan Municipal An-Nan Hospital, Tainan City, Taiwan.
Thorac Cancer. 2020 Sep;11(9):2672-2680. doi: 10.1111/1759-7714.13604. Epub 2020 Aug 6.
This study aimed to evaluate the characteristics of patients with newly diagnosed advanced lung cancer who initially presented with respiratory failure.
This was a retrospective study which analyzed patients in the intensive care unit (ICU) with newly diagnosed advanced lung cancer who were placed on mechanical ventilation (MV). We defined newly diagnosed lung cancer as pathological or molecular results for treatment decisions not yet determined when the patient was admitted to ICU.
During the 14-year inclusion period, 845 lung cancer patients requiring MV were screened. A total of 56 newly diagnosed extensive lung cancer patients were analyzed. Cancer-related to central airway obstruction (n = 29, 51.8%) was the leading cause of respiratory failure. The significant etiologies of delay in the diagnosis of lung cancer were diagnostic error, mistaking cancer for tuberculosis, and missed hilar lesions. The six-month survival rate was only 7.1% (n = 4). The sequential organ failure assessment (SOFA) score was significantly associated with mortality (HR = 1.142, 95% CI = 1.012-1.288, P = 0.031). The six-month survival rate in patients receiving suitable targeted therapy and accepting chemotherapy and best supportive care was 40% (2/5), 0% (0/7), and 4.5% (2/44), respectively.
Patients with newly diagnosed advanced lung cancer with acute life-threatening respiratory failure have poor outcomes. Cancer-related to central airway obstruction is a leading cause of respiratory failure. Diagnostic errors such as tuberculosis and missed hilar lesions are the two main etiologies of a delay in diagnosis. The SOFA score is correlated with mortality. Targeted therapy can raise the six-month survival rates in patients with oncogenic mutation adenocarcinoma, who survive after presentation in a critical condition.
本研究旨在评估初诊为晚期肺癌且伴有急性呼吸衰竭的患者的临床特征。
这是一项回顾性研究，分析了入住重症监护病房（ICU）且因新发晚期肺癌行机械通气（MV）的患者。我们将新诊断的肺癌定义为患者入住 ICU 时尚未确定治疗决策的病理或分子结果。
在 14 年的纳入期间，共筛选出 845 例需要 MV 的肺癌患者。共有 56 例新诊断的广泛期肺癌患者进行了分析。癌症导致的中央气道阻塞（n=29，51.8%）是导致呼吸衰竭的主要原因。导致肺癌诊断延迟的重要病因包括诊断错误、将癌症误诊为肺结核以及肺门病变漏诊。6 个月的生存率仅为 7.1%（n=4）。序贯器官衰竭评估（SOFA）评分与死亡率显著相关（HR=1.142，95%CI=1.012-1.288，P=0.031）。接受合适靶向治疗和接受化疗及最佳支持治疗的患者 6 个月生存率分别为 40%（2/5）、0%（0/7）和 4.5%（2/44）。
初诊为伴有急性生命威胁性呼吸衰竭的晚期肺癌患者预后较差。癌症导致的中央气道阻塞是呼吸衰竭的主要原因。肺结核和肺门病变漏诊等诊断错误是导致诊断延迟的两个主要病因。SOFA 评分与死亡率相关。对于携带致癌基因突变的腺癌患者，靶向治疗可提高其 6 个月生存率，这些患者在危急情况下就诊后可存活。
