重症监护治疗的转移性睾丸癌患者住院姑息治疗的应用：来自全国住院患者样本的见解
Use of inpatient palliative care in metastatic testicular cancer patients undergoing critical care therapy: insights from the national inpatient sample.
作者信息
Cano Garcia Cristina, Incesu Reha-Baris, Barletta Francesco, Morra Simone, Scheipner Lukas, Baudo Andrea, Tappero Stefano, Piccinelli Mattia Luca, Tian Zhe, Saad Fred, Shariat Shahrokh F, Terrone Carlo, De Cobelli Ottavio, Carmignani Luca, Ahyai Sascha, Longo Nicola, Tilki Derya, Briganti Alberto, Banek Severine, Kluth Luis A, Chun Felix K H, Karakiewicz Pierre I
机构信息
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
Department of Urology, Goethe University Frankfurt, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt, Germany.
出版信息
Sci Rep. 2025 Jan 6;15(1):967. doi: 10.1038/s41598-024-83545-7.
To test for rates of inpatient palliative care (IPC) in metastatic testicular cancer patients receiving critical care therapy (CCT). Within the Nationwide Inpatient Sample (NIS) database (2008-2019), we tabulated IPC rates in metastatic testicular cancer patients receiving CCT, namely invasive mechanical ventilation (IMV), percutaneous endoscopic gastrostomy tube (PEG), dialysis for acute kidney failure (AKF), total parenteral nutrition (TPN) or tracheostomy. Univariable and multivariable logistic regression models addressing IPC were fitted. Of 420 metastatic testicular cancer patients undergoing CCT, 70 (17%) received IPC. Between 2008 and 2019, the rates of IPC among metastatic testicular cancer patients undergoing CCT increased from 5 to 19%, with the highest rate of 30% in 2018 (EAPC: + 9.5%; 95% CI + 4.7 to + 15.2%; p = 0.005). IPC patients were older (35 vs. 31 years, p = 0.01), more frequently had do not resuscitate (DNR) status (34 vs. 4%, p < 0.001), more frequently exhibited brain metastases (29 vs. 17%, p = 0.03), were more frequently treated with IMV (76 vs. 53%, p < 0.001) and exhibited higher rate of inpatient mortality (74 vs. 29%, p < 0.001). In multivariable analyses, DNR status (OR 10.23, p < 0.001) and African American race/ethnicity (OR 4.69, p = 0.003) were identified as independent predictors of higher IPC use. We observed a significant increase in rates of IPC use in metastatic testicular cancer patients receiving CCT, rising from 5 to 19% between 2008 and 2019. However, this rates remain lower compared to metastatic lung cancer patients, indicating the need for further awareness among clinicians treating metastatic testicular cancer. The increase in IPC rates for metastatic testicular cancer patients receiving CCT indicates a need for ongoing education and awareness among healthcare providers. This could enhance the integration of IPC in the treatment of advanced cancer, potentially improving quality of life and care outcomes for survivors.
为了检测接受重症监护治疗（CCT）的转移性睾丸癌患者的住院姑息治疗（IPC）率。在全国住院患者样本（NIS）数据库（2008 - 2019年）中，我们统计了接受CCT的转移性睾丸癌患者的IPC率，即有创机械通气（IMV）、经皮内镜下胃造瘘管（PEG）、急性肾衰竭（AKF）透析、全胃肠外营养（TPN）或气管切开术。构建了针对IPC的单变量和多变量逻辑回归模型。在420例接受CCT的转移性睾丸癌患者中，70例（17%）接受了IPC。2008年至2019年间，接受CCT的转移性睾丸癌患者的IPC率从5%上升至19%，2018年最高达30%（EAPC：+9.5%；95%CI +4.7至+15.2%；p = 0.005）。接受IPC的患者年龄更大（35岁对31岁，p = 0.01），更频繁地有不进行心肺复苏（DNR）状态（34%对4%，p < 0.001），更频繁地出现脑转移（29%对17%，p = 0.03），更频繁地接受IMV治疗（76%对53%，p < 0.001），且住院死亡率更高（74%对29%，p < 0.001）。在多变量分析中，DNR状态（OR 10.23，p < 0.001）和非裔美国人种族/族裔（OR 4.69，p = 0.003）被确定为IPC使用增加的独立预测因素。我们观察到接受CCT的转移性睾丸癌患者的IPC使用率显著增加，在2008年至2019年间从5%上升至19%。然而，与转移性肺癌患者相比，这一比率仍然较低，表明治疗转移性睾丸癌的临床医生需要进一步提高认识。接受CCT的转移性睾丸癌患者IPC率的增加表明医疗保健提供者需要持续开展教育并提高认识。这可以加强IPC在晚期癌症治疗中的整合，有可能改善幸存者的生活质量和护理结果。
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