Pathak Priya, Laredo Jonathan, Swain Sonal, Nguyen Benjamin, Gallagher Scott F, Freeman Jennifer, Agarwal Suresh M, Haines Krista L
The Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
Department of Surgery, Duke University School of Medicine, Durham, North Carolina; The University of Tennessee Health Science Center, Memphis, Tennessee.
J Surg Res. 2025 Aug;312:227-235. doi: 10.1016/j.jss.2025.05.017. Epub 2025 Jun 30.
Severe traumatic injuries are frequently associated with poor outcomes, and withdrawal of life-sustaining treatment (WLST) after traumatic brain injury is common. However, the association between WLST and pre-existing cancer in all trauma patients remains underexplored.
This retrospective cohort study analyzed data from the American College of Surgery Trauma Quality Programs in 2022. Patients aged 18 y or older with information on pre-existing disseminated cancer and chemotherapy status at the time of trauma were included. Descriptive statistics and multiple logistic regression, combined with propensity score matching, were used to assess the association between WLST and pre-existing cancer after traumatic injury.
A total of 936,410 patients met the study criteria. Of these, 3827 (0.4%) were undergoing chemotherapy without metastatic cancer, 1528 (0.2%) had metastatic cancer but were not receiving chemotherapy, while 5399 (0.6%) were on chemotherapy. Significant differences in patient demographics, injury characteristics, and outcomes were observed across these groups. After matching on age, sex, race and ethnicity, insurance, injury severity, region and type, advance directives (ADs), functional dependence, prehospital cardiac arrest, and initial Glasgow Coma Scale, the adjusted odds ratio for WLST was 2.02 (95% CI: 1.39-2.95) for patients with metastatic cancer not on chemotherapy and 2.47 (95% confidence interval [CI]: 1.78-3.42) for patients with metastatic cancer on chemotherapy, compared to patients without cancer. Severe injuries were associated with 2.83 times higher odds of WLST (95% CI: 2.42-3.71) compared to mild injuries. Patients with chest, abdominal, and extremity injuries had lower odds of WLST compared to head and neck injuries. The presence of ADs limiting care was strongly associated with WLST (adjusted odds ratio: 3.62, 95% CI: 2.91-4.51).
Patients with metastatic cancer, regardless of chemotherapy status, had up to three times higher odds of WLST after traumatic injury. The presence of ADs was also strongly linked to increased WLST, emphasizing the importance of patient preferences and personalized care approaches in end-of-life decisions for cancer patients in trauma settings.
严重创伤性损伤常伴有不良预后，创伤性脑损伤后放弃维持生命治疗（WLST）很常见。然而，在所有创伤患者中，WLST与既往癌症之间的关联仍未得到充分研究。
这项回顾性队列研究分析了2022年美国外科医师学会创伤质量项目的数据。纳入年龄在18岁及以上、有创伤时既往播散性癌症信息和化疗状态信息的患者。描述性统计和多因素逻辑回归，结合倾向评分匹配，用于评估创伤性损伤后WLST与既往癌症之间的关联。
共有936410名患者符合研究标准。其中，3827名（0.4%）正在接受化疗但无转移性癌症，1528名（0.2%）有转移性癌症但未接受化疗，5399名（0.6%）正在接受化疗。这些组在患者人口统计学、损伤特征和预后方面存在显著差异。在对年龄、性别、种族和民族、保险、损伤严重程度、地区和类型、预先指示（ADs）、功能依赖、院前心脏骤停和初始格拉斯哥昏迷量表进行匹配后，与无癌症患者相比，未接受化疗的转移性癌症患者WLST的调整比值比为2.02（95%置信区间[CI]：1.39 - 2.95），接受化疗的转移性癌症患者WLST的调整比值比为2.47（95%置信区间[CI]：1.78 - 3.42）。与轻度损伤相比，严重损伤与WLST的比值比高2.83倍（95% CI：2.42 - 3.71）。与头部和颈部损伤相比，胸部、腹部和四肢损伤患者WLST的几率较低。存在限制护理的ADs与WLST密切相关（调整比值比：3.62，95% CI：2.91 - 4.51）。
无论化疗状态如何，转移性癌症患者创伤性损伤后WLST的几率高达三倍。ADs的存在也与WLST增加密切相关，强调了患者偏好和个性化护理方法在创伤环境中癌症患者临终决策中的重要性。
