Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Am J Med Sci. 2024 Oct;368(4):346-354. doi: 10.1016/j.amjms.2024.05.023. Epub 2024 May 31.
The aim of this study was to compare the clinical characteristics and outcomes of gastrointestinal bleeding (GIB) between cancer patients (CP) and non-cancer patients (NCP).
This was a prospective study of patients admitted with overt GIB between 2013 and 2021. GIB etiology, management and outcomes including rebleeding and mortality, were compared between CP and NCP, and among patients with different types of cancer. The associations with categorical variables were assessed with the Chi-square test, and the t-test was used for continuous variables.
Of 674 patients admitted for GIB, 144 (21%) had cancer. 121(84%) CP had active disease, 49% had stage 4 cancer, and 78% had solid tumors, of whom 28 (20%) had luminal GI cancers. The most common were colorectal cancer, prostate cancer, and lymphomas. Compared to NCP, CP had higher age-adjusted Charlson Comorbidity Index, and were less likely to undergo endoscopy or endoscopic therapy. Severe GIB was equally prevalent in both groups, but CP had more severe anemia. Peptic ulcer was the most common etiology in both groups. Of 28 luminal cancer patients, 17(59%) bled from their tumors. Nine patients bled from cancer metastasis to the GI lumen. CP had higher in-hospital, one-month, one-year, and end-of-follow-up mortality. Length of hospital stay and re-bleeding rates did not differ between CP and NCP.
CP with GIB are less likely to have diagnostic and therapeutic endoscopy and have higher mortality than NCP. Steps to identify CP at risk for GIB and to improve their outcomes merit further investigation.
本研究旨在比较癌症患者（CP）和非癌症患者（NCP）胃肠道出血（GIB）的临床特征和结局。
这是一项前瞻性研究，纳入了 2013 年至 2021 年间因显性 GIB 住院的患者。比较了 CP 和 NCP 之间的 GIB 病因、治疗和结局，包括再出血和死亡率，以及不同类型癌症患者之间的差异。采用卡方检验评估分类变量的相关性，采用 t 检验评估连续变量的相关性。
在 674 例因 GIB 住院的患者中，144 例（21%）患有癌症。121 例（84%）CP 为活动性疾病，49%为 4 期癌症，78%为实体瘤，其中 28 例（20%）为腔道 GI 癌症。最常见的是结直肠癌、前列腺癌和淋巴瘤。与 NCP 相比，CP 的年龄调整 Charlson 合并症指数更高，接受内镜检查或内镜治疗的可能性更低。两组严重 GIB 的发生率相当，但 CP 的贫血更严重。消化性溃疡是两组最常见的病因。在 28 例腔道癌症患者中，17 例（59%）的肿瘤出血。9 例患者的癌症转移到胃肠道腔道导致出血。CP 的院内、1 个月、1 年和随访结束时的死亡率更高。CP 和 NCP 的住院时间和再出血率无差异。
CP 伴 GIB 进行诊断性和治疗性内镜检查的可能性较低，死亡率高于 NCP。进一步调查确定 CP 发生 GIB 的风险并改善其结局的措施是必要的。
