Mid- and long-term follow-up experience in patients with malignant superior vena cava obstruction
Mid- and long-term follow-up experience in patients with malignant superior vena cava obstruction
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DOI：
10.1093/icvts/ivs562
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发表时间：
2013-04-01
影响因子：
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通讯作者：
Cheng, Stephen Wing-Keung
中科院分区：
文献类型：
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作者：
Chan, Richie Chiu-Lung;Chan, Yiu Che;Cheng, Stephen Wing-Keung
有丝分裂疾病引起的上级腔静脉阻塞（SVCO）是一种严重的疾病，具有显著的发病率和死亡率。本研究旨在回顾性分析玛丽医院外科收治的SVCO患者14年的随访数据和人口统计学资料，并前瞻性分析1997年10月至2011年9月在玛丽医院玛丽医院收治的SVCO患者的临床数据。对所有患者记录进行了电子和手动检索。使用Kaplan-Meier生存曲线分析计算生存率。Mantel-Cox对数秩检验用于检验统计学显著性差异。研究了人口统计学数据、相关病因、干预和结局。仅纳入恶性肿瘤患者，共纳入104例患者（男性81例，女性23例）。就诊时的中位年龄为65岁（范围3-91岁）。中位随访期为2个月。最常见的原因是支气管肺癌（71%），其次是胸外恶性肿瘤（16%），淋巴瘤（8%）和胸腺恶性肿瘤（3%）。从症状发作到出现的平均时间为34天。大多数（93.9%）患者使用类固醇。约一半（54.4%）的患者接受了放射治疗。仅7例患者接受了血管成形术，所有患者均植入了支架。总体生存率很差。平均和中位生存期分别为8.4和1.6个月。17%的患者在初次就诊时死于同一住院期间。在单变量分析中，年龄较小（50岁或以下; P = 0.000）、从不吸烟（P = 0.012）、不使用类固醇（P = 0.007）和某些原发病因（例如淋巴瘤; P = 0.008）与总生存期较长相关。然而，在多变量分析中，这些因素均未达到统计学显著性。淋巴瘤、胸外恶性肿瘤、支气管肿瘤和胸腺肿瘤的平均生存期分别为80.1、3.4、3.1和1.8个月。血管成形术与总生存率无统计学显著相关性。据我们所知，本研究首次研究了可能影响恶性SVCO生存结局的预后因素。我们发现，在恶性病因的SVCO患者中，高龄（50岁以上）、吸烟史和使用类固醇与不良结局有统计学显著相关。潜在的原发恶性病因也具有重要的预后意义。尽管医学进步，SVCO患者的预后仍然很严重。
Superior vena cava obstruction (SVCO) due to mitotic diseases is a serious condition with significant morbidity and mortality. The aim of this study was to examine the follow-up data and demographics of patients with SVCO admitted to the Department of Surgery, Queen Mary Hospital, over a 14-year period.The prospectively entered clinical data of patients with SVCO in Queen Mary Hospital from October 1997 to September 2011 were retrospectively analysed. All patient records were electronically and manually searched. Survival was calculated using Kaplan-Meier survival curves analysis. The Mantel-Cox log-rank test was used to test for statistically significant differences. Demographic data, associated aetiology, intervention and outcome were studied. Only patients with malignant aetiologies were included.A total of 104 patients (81 males and 23 females) were recruited in our study period. Median age at presentation was 65 (range 3-91 years). The median follow-up period was 2 months. The commonest cause of SVCO was bronchogenic carcinoma (71%), followed by extrathoracic malignancies (16%), lymphoma (8%) and thymic malignancy (3%). The mean time from the onset of symptoms to presentation was 34 days. Steroids were prescribed for most (93.9%) of the patients. About half (54.4%) of the patients were given radiotherapy. Only 7 patients had angioplasty and all of them had stents inserted. The overall survival was poor. The mean and median survivals were 8.4 and 1.6 months, respectively. Seventeen percent of patients died in the same hospitalization as for their initial presentations. Younger age (50 years or below; P = 0.000), never smoker (P = 0.012), not using steroids (P = 0.007) and certain primary aetiologies (e.g. lymphoma; P = 0.008) were associated with longer overall survival on univariate analysis. However, on multivariate analysis, none of these factors reached statistical significance. The mean survival for cases with lymphoma, extrathoracic malignancies, bronchogenic tumours and thymic tumours was 80.1, 3.4, 3.1 and 1.8 months, respectively. Angioplasty did not show a statistically significant association with the overall survival.This study, to the best of our knowledge, is the first to study the prognostic factors that may affect survival outcome in malignant SVCO. We showed that in patients with malignant aetiology for SVCO, advanced age (more than 50), history of smoking and use of steroids were statistically significantly associated with a poor outcome. The underlying primary malignant aetiology also has an important prognostic significance. Despite advances in medicine, the prognosis of patients with SVCO is still grave.