接受化疗的成年血液系统癌症患者计划外早期拔除植入式静脉导管的危险因素：一项倾向评分匹配研究
Risk Factors for Unplanned Early Implantable Port Catheter Removal in Adult Hematology Cancer Patients Receiving Chemotherapy: A Propensity Score Matching Study.
作者信息
Lu Ming-Shian, Chen Chih-Chen, Chang Che-Chia, Lin Chien-Chao, Hsieh Ching-Chuan
机构信息
Department of Surgery, Chang Gung Memorial Hospital at Chiayi, Puzi City, Taiwan.
Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
出版信息
Cancer Manag Res. 2024 May 8;16:445-454. doi: 10.2147/CMAR.S454063. eCollection 2024.
PURPOSE
Implantable port catheter is a reliable vascular access for chemotherapy infusion in cancer patients. However, patients with hematology malignancies usually present with a myriad of blood cell abnormalities that put them at risk of infection and mechanical problems requiring catheter removal. This study aims to determine the risk factors associated with unplanned (catheter removal other than completion of treatment plan) early (within 90 days of catheter implantation) implantable port catheter removal.
PATIENTS AND METHODS
A retrospective, propensity score-matched study of 386 patients with hematology malignancies who received implantable venous access ports between January 2015 and December 2022. We conducted a univariate analysis to select the variables for propensity score matching. Patients with unplanned early implantable port catheter removal (early group) were matched 1:1 to patients without unplanned early removal (non-early group).
RESULTS
Univariate analysis demonstrated a statistically significant difference between early and non-early groups for age (p = 0.048), hemoglobin level (p = 0.028), thrombocytopenia (p = 0.025), and PG-SGA (p < 0.001). Thrombocytopenia was the only independent risk factor with a statistically significant difference in Cox proportional hazard analysis, HR 2.823, 95 CI 1.050-7.589, p = 0.040. The median catheter survival for patients with thrombocytopenia was 61 days (95% CI 28.58-93.42) compared to 150 days (95% CI 9.81-290.19) for patients without thrombocytopenia, p = 0.015. Patient survival is not affected by early catheter removal. The median survival for patients in the early group was 28.28 months (95% CI 27.43-29.15) compared to 32.39 months (95% CI 24.11-40.68), for the non-early group, p = 0.709.
CONCLUSION
Hematology malignancy patients with thrombocytopenia are at high risk for unplanned early port catheter removal without survival difference.
目的
植入式端口导管是癌症患者化疗输注可靠的血管通路。然而，血液系统恶性肿瘤患者通常存在多种血细胞异常，这使他们面临感染风险以及出现需要拔除导管的机械问题。本研究旨在确定与计划外（非因完成治疗计划而拔除导管）早期（导管植入后90天内）拔除植入式端口导管相关的危险因素。
患者与方法
一项对2015年1月至2022年12月期间接受植入式静脉通路端口的386例血液系统恶性肿瘤患者进行的回顾性、倾向评分匹配研究。我们进行了单因素分析以选择倾向评分匹配的变量。计划外早期拔除植入式端口导管的患者（早期组）与未计划外早期拔除的患者（非早期组）进行1:1匹配。
结果
单因素分析显示，早期组与非早期组在年龄（p = 0.048）、血红蛋白水平（p = 0.028）、血小板减少（p = 0.025）和患者主观全面评定法（PG-SGA）（p < 0.001）方面存在统计学显著差异。在Cox比例风险分析中，血小板减少是唯一具有统计学显著差异的独立危险因素，风险比（HR）为2.823，95%置信区间（CI）为1.050 - 7.589，p = 0.040。血小板减少患者的导管中位存活时间为61天（95% CI 28.58 - 93.42），而无血小板减少患者为150天（95% CI 9.81 - 290.19），p = 0.015。早期拔除导管不影响患者生存。早期组患者的中位生存期为28.28个月（95% CI 27.43 - 29.15），非早期组为32.39个月（95% CI 24.11 - 40.68），p = 0.709。
结论
血小板减少的血液系统恶性肿瘤患者计划外早期拔除端口导管的风险高，但生存无差异。
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