Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan; Cancer Chemotherapy Center, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan.
Ann Palliat Med. 2024 Jul;13(4):842-857. doi: 10.21037/apm-23-554. Epub 2024 Apr 18.
Malignant ascites (MA) is common in patients with advanced cancer, and about 60% of patients with MA experience distressing symptoms. In addition, MA has been identified as a poor prognostic factor, therefore, making the management of MA an important issue. We aimed to review literature describing MA provide a narrative synthesis of relevant studies.
A literature search of articles published between 1971 and May 2023 was performed in PubMed, and Cochrane library using the words "ascites/malignant ascites" and the theme of each section. Authors independently selected the articles used and summarized. Finally, this manuscript was obtained consensus through discussed among all authors.
The pathophysiological mechanism of ascites formation involves increased vascular permeability and impaired fluid drainage through the lymphatic system, which explain the occurrence of peritoneal carcinomatosis, portal hypertension due to liver tumors, liver cirrhosis in the background of hepatocellular carcinoma, and Budd-Chiari syndrome caused by tumor occlusion of the hepatic vein. The efficacy and safety of various treatments and procedures have been investigated previously; however, no treatment guidelines have been established yet. Diuretics and paracentesis are often selected as the first lines of treatment. Intraperitoneal drug administration (catumaxomab, bevacizumab, aflibercept, hyperthermic intraperitoneal chemotherapy, triamcinolone), indwelling peritoneal catheters, peritoneovenous shunting, and cell-free and concentrated ascites reinfusion therapy are commonly used to manage refractory ascites. A new device for this purpose is alfapump, which transfers ascites fluid from the peritoneum into the urinary bladder. In addition, thoracic epidural analgesia may be effective for managing ascites-related symptoms.
Despite these options, no standard treatment for MA has been established yet because few trials have been conducted in this area. There are many issues to be investigated, and future research and treatment development are expected.
恶性腹水（MA）在晚期癌症患者中很常见，约 60%的 MA 患者有痛苦症状。此外，MA 已被确定为预后不良的因素，因此，MA 的管理是一个重要的问题。我们旨在回顾描述 MA 的文献，并对相关研究进行叙述性综合。
在 PubMed 和 Cochrane 图书馆中，使用“腹水/恶性腹水”和每个部分的主题的词，对 1971 年至 2023 年 5 月期间发表的文章进行了文献检索。作者独立选择使用的文章并进行总结。最后，通过所有作者讨论达成共识，获得本文。
腹水形成的病理生理机制涉及血管通透性增加和通过淋巴系统受损的液体引流，这解释了腹膜癌病、肿瘤引起的门脉高压、肝癌背景下的肝硬化以及肿瘤阻塞肝静脉引起的 Budd-Chiari 综合征的发生。以前已经研究了各种治疗和程序的疗效和安全性，但尚未建立治疗指南。利尿剂和腹腔穿刺术通常被选为一线治疗。腹腔内药物给药（Catumaxomab、贝伐单抗、阿柏西普、腹腔内热化疗、曲安奈德）、留置腹腔导管、腹膜静脉分流、无细胞和浓缩腹水再输注治疗常用于治疗难治性腹水。为此目的的一种新设备是 alfapump，它将腹水从腹膜转移到膀胱。此外，胸腔硬膜外镇痛可能对管理腹水相关症状有效。
尽管有这些选择，但由于该领域的试验很少，尚未为 MA 确立标准治疗方法。有许多问题需要调查，预计未来会有更多的研究和治疗发展。
