Fan Kristie Huirong, Patel Pinal S, Maddison Rebecca, McKenzie Emma, Wilson Nicola, Massey Dunecan, Woodward Jeremy, Rutter Charlotte
Cambridge Centre for Intestinal Rehabilitation and Transplant, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Division of Gastroenterology & Hepatology, Department of Medicine, National University Hospital, Singapore.
BMJ Open Gastroenterol. 2025 Aug 19;12(1):e001822. doi: 10.1136/bmjgast-2025-001822.
Intestinal failure in advanced malignancy is most commonly due to mechanical bowel obstruction. Palliative home parenteral nutrition (HPN) is an option for such patients to meet their nutritional needs. However, there are limited data on overall survival and predictive factors. This study aimed to evaluate the survival of patients receiving palliative HPN and the impact of patient factors on survival.
This is a single-centre retrospective observational study of patients referred for palliative HPN from 1 January 2020 to 19 November 2024 at the Cambridge University Hospitals NHS Foundation Trust. Demographic, nutritional and medical data were analysed. Survival rates were compared using Kaplan-Meier curves and Cox regression.
84 patients were referred and 77 were discharged with HPN (median age was 60.9 years (IQR: 51.3-70.4), female 77%). 78% of the underlying primary malignancies were gynaecological and gastrointestinal. Malignant bowel obstruction was the main indication for HPN (86%). Eastern Cooperative Oncology Group performance status (PS) scores were ≤2 in 82% of patients and 75% had an estimated prognosis of >3 months. Median survival was 58 days (IQR 31-108) with a 3-month mortality of 69%. There was no statistical difference in survival by PS, estimated prognosis, underlying malignancy or modified Glasgow Prognostic Score (mGPS).
The overall survival in our study is modest. PS, prognosis, mGPS or tumour type did not show a significant impact on survival. This highlights the challenges in artificial nutrition and emphasises the role of a multidisciplinary team in the care of these patients.
晚期恶性肿瘤患者出现肠衰竭最常见的原因是机械性肠梗阻。姑息性家庭肠外营养（HPN）是满足此类患者营养需求的一种选择。然而，关于总生存期和预测因素的数据有限。本研究旨在评估接受姑息性HPN患者的生存期以及患者因素对生存期的影响。
这是一项单中心回顾性观察研究，研究对象为2020年1月1日至2024年11月19日在剑桥大学医院国民保健服务信托基金转诊接受姑息性HPN的患者。对人口统计学、营养和医学数据进行了分析。使用Kaplan-Meier曲线和Cox回归比较生存率。
84例患者被转诊，77例患者接受HPN出院（中位年龄为60.9岁（四分位间距：51.3 - 70.4），女性占77%）。78%的潜在原发性恶性肿瘤为妇科和胃肠道肿瘤。恶性肠梗阻是HPN的主要适应证（86%）。82%的患者东部肿瘤协作组体能状态（PS）评分≤2，75%的患者预计预后>3个月。中位生存期为58天（四分位间距31 - 108），3个月死亡率为69%。PS、预计预后、潜在恶性肿瘤或改良格拉斯哥预后评分（mGPS）对生存期无统计学差异。
我们研究中的总生存期一般。PS、预后、mGPS或肿瘤类型对生存期未显示出显著影响。这凸显了人工营养方面的挑战，并强调了多学科团队在这些患者护理中的作用。
