Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA, USA.
Stanford University School of Medicine, 430 Broadway, Pavilion C, 3rd Floor, Redwood City, CA, 94063, USA.
BMC Gastroenterol. 2022 Sep 5;22(1):410. doi: 10.1186/s12876-022-02487-4.
Malignancy-related ascites accounts for approximately 10% of causes of ascites. Our AIM was to characterize the ascites fluid and correlate clinical outcomes in those with extrahepatic malignancy and ascites.
241 subjects with extrahepatic solid tumors and ascites were reviewed from 1/1/2000 to 12/31/2019, 119 without liver metastasis and 122 with liver metastasis.
Ascites fluid consistent with peritoneal carcinomatosis (PC) was most common, 150/241 (62%), followed by fluid reflecting the presence of portal hypertension (PH), 69/241 (29%). 22/241 (9%) had low SAAG and low ascites fluid total protein, with evidence of PC on cytology and or imaging in 20/22. Lung cancer was the most common malignancy in subjects with ascites due to PC at 36/150 (24%), pancreatic cancer was the most common in subjects with ascites with features of PH at 16/69 (23%). Chemotherapy or immunotherapy alone was the most common management approach. Significantly higher 5-year, 3-year and 1-year mortality rate were noted in subjects with evidence of PC on cytology/imaging versus subjects with no evidence of PC, and in subjects with liver metastasis compared to subjects without liver metastasis. Subjects with pancreatic cancer and evidence of PC on cytology/imaging had higher 1 and 5-year mortality rates compared to subjects without PC.
Ascites in solid tumor malignancy is most commonly due to PC. We also observed ascites fluid with characteristics of PH in 29% of subjects. Higher mortality rates in subjects with peritoneal carcinomatosis and liver metastasis were noted. These findings may help inform prognosis and treatment strategies.
恶性肿瘤相关性腹水约占腹水病因的 10%。我们的目的是分析肝外恶性肿瘤合并腹水患者的腹水特征，并探讨其与临床结局的相关性。
回顾性分析 2000 年 1 月 1 日至 2019 年 12 月 31 日期间收治的 241 例肝外实体瘤合并腹水患者的临床资料，其中 119 例患者无肝转移，122 例患者有肝转移。
腹水符合腹膜转移（peritoneal carcinomatosis，PC）的患者最为常见（150/241，62%），其次为反映门静脉高压（portal hypertension，PH）的腹水（69/241，29%）。22/241（9%）患者腹水的血清腹水白蛋白梯度（serum ascites albumin gradient，SAAG）较低，腹水总蛋白含量较低，细胞学和（或）影像学检查证实存在 PC，其中 20/22 例患者符合这一特征。PC 相关腹水患者中最常见的恶性肿瘤为肺癌（36/150，24%），PH 相关腹水患者中最常见的恶性肿瘤为胰腺癌（16/69，23%）。单独应用化疗或免疫治疗是最常见的治疗方法。与无 PC 患者相比，有 PC 细胞学/影像学证据的患者的 5 年、3 年和 1 年生存率显著降低，与无肝转移患者相比，有肝转移患者的生存率显著降低。有 PC 细胞学/影像学证据且患有胰腺癌的患者的 1 年和 5 年死亡率均高于无 PC 的患者。
在实体瘤恶性肿瘤患者中，腹水最常见的原因为 PC。我们还观察到 29%的患者存在 PH 相关腹水。PC 和肝转移患者的死亡率较高。这些发现可能有助于预测预后和治疗策略。
