Torigoe Tomoaki, Imanishi Jungo, Yazawa Yasuo, Koyama Tadaaki, Kadono Yuho, Oda Hiromi, Saita Kazuo
Department of Orthopedic Oncology and Surgery Saitama Medical University International Medical Center Hidaka Japan.
Division of Orthopedic Oncology Shizuoka Cancer Center Hospital Nagaizumi Japan.
Acute Med Surg. 2021 Feb 4;8(1):e600. doi: 10.1002/ams2.600. eCollection 2021 Jan-Dec.
Patients with skeletal metastasis from prediagnosed primary malignancy sometimes have concurrent oncologic emergency (OE) during the first visit. This study aims to investigate the types of OEs and treatment outcome in such patients.
We have experienced 359 patients with skeletal metastasis from unknown primary malignancy. Among them, 130 patients required immediate admission for OE treatment (OE group), 229 patients had no OE and did not required immediate admission (non-OE group).
The recognized types of OE were spinal cord compression in 60 patients, cancer pain in 30, hypercalcemia in 19, delirium in 16, deep vein thrombosis in 13, acute renal failure in 6, respiratory failure in 3, gastrointestinal hemorrhage in 3, and disseminated intravascular coagulation in 1. The overall 5-year survival rates were 28% and 37% in the OE and non-OE groups, respectively ( < 0.001). The multivariate analysis revealed that delirium (hazard ratio 4.2; 95% confidence interval, 1.6-12.5; < 0.005) and respiratory failure (hazard ratio 22.6; 95% confidence interval, 4.5-92.8; < 0.001) were significant prognostic factors in patients with OEs, whereas other OEs did not confer a significant risk for patient outcomes.
In this study, OE was observed in as many as 36% of patients with skeletal metastasis from unknown primary malignancy. Delirium and respiratory failure were only two significant prognostic risk factors, which suggest that many of the OEs in untreated advanced cancer patients have probable chance to resolve. Early detection followed by appropriate treatment of such OEs is recommended.
预先诊断为原发性恶性肿瘤的骨转移患者在首次就诊时有时会并发肿瘤急症（OE）。本研究旨在调查此类患者的肿瘤急症类型及治疗结果。
我们收治了359例原发灶不明的骨转移患者。其中，130例患者因肿瘤急症治疗需要立即入院（肿瘤急症组），229例患者无肿瘤急症且无需立即入院（非肿瘤急症组）。
确认的肿瘤急症类型包括脊髓压迫60例、癌痛30例、高钙血症19例、谵妄16例、深静脉血栓形成13例、急性肾衰竭6例、呼吸衰竭3例、胃肠道出血3例、弥散性血管内凝血1例。肿瘤急症组和非肿瘤急症组的总体5年生存率分别为28%和37%（P<0.001）。多因素分析显示，谵妄（风险比4.2；95%置信区间，1.6 - 12.5；P<0.005）和呼吸衰竭（风险比22.6；95%置信区间，4.5 - 92.8；P<0.001）是肿瘤急症患者的重要预后因素，而其他肿瘤急症对患者预后无显著风险。
在本研究中，36%的原发灶不明的骨转移患者出现了肿瘤急症。谵妄和呼吸衰竭是仅有的两个重要预后风险因素，这表明许多未经治疗的晚期癌症患者的肿瘤急症有可能得到缓解。建议对此类肿瘤急症进行早期检测并给予适当治疗。
