大连高级别胰腺癌患者临终治疗的保守疗法和侵入性疗法
高级别胰腺癌患者临终治疗的保守疗法和侵入性疗法
摘要（英中对照）：
Background: We examined the impact of palliativecare (PC) on aggressiveness of end-of-life care for patients with advancedpancreatic cancer. Measures of aggressive care included chemotherapy within 14days of death; and at least one intensive care unit (ICU) admission, more thanone emergency department (ED) visit, and more than one hospitalization, allwithin 30 days of death.
背景：我们研究了高级别胰腺癌患者临终关怀的保守治疗方法的作用。侵入性治疗的措施包括死亡前14天之内的化疗，和至少一次ICU住院，至少一次的急诊，和超过一次的住院，这些都是在死亡前30天内进行的。
Methods: Aretrospective population-based cohort study using administrative data wasconducted in patients with advanced pancreatic cancer from 2005 to 2010 inOntario, Canada. Multivariable logisticregression was performed with the above measures of aggressive care as the outcomes of interest and PC as the main exposure, adjusting for covariables.Secondary analyses examined intensity of PC as the main exposure defined in twoways: 1) absolute number of PC visits before the outcome of interest (0, 1, 2,3+ visits) and 2) monthly rate of PC visits.
方法：以2005年至2010年之间加拿大Ontario的患有高级别胰腺癌患者的住院数据为基础，进行了一个回顾性、人口为基础的队列试验。调整变量，以上述侵入性治疗措施作为评估结果，保守治疗作为主要暴露进行多变量逻辑回归分析。次要分析检测保守治疗强度主要暴露规定了2种方法：1)在评估结果前的保守治疗访视的绝对数量(0, 1, 2, 3+ 访视)和 2)保守治疗访视月访视率。
Results: Thecohort included 5381 patients (median survival 75 days); 2816 (52.3%) hadreceived a PC consultation. PCconsultation was associated with decreased use of chemotherapy near death (oddsratio [OR] = 0.34, 95% confidence interval [CI] = 0.25 to 0.46); lower risk ofICU admission: OR = 0.12, 95% CI = 0.08 to 0.18; multiple ED visits: OR = 0.19,95% CI = 0.16 to 0.23; multiple hospitalizations near death: OR = 0.24, 95% CI= 0.19 to 0.31). A per-unit increase in the monthly rate of PC visitswas associated with lower odds of aggressive care for all four outcomes.
结果：本研究队列纳入5381例患者（生存中位数是75天）；2816 例(52.3%)进行过保守治疗咨询。保守治疗咨询与接近死亡使用化疗相关（比值比[OR]=0.34, 95%置信区间CI=0.25 -0.46);低风险ICU住院: OR = 0.12, 95% CI = 0.08 - 0.18;多次急诊: OR = 0.19, 95% CI = 0.16 - 0.23;接近死亡时的多次住院: OR = 0.24, 95% CI = 0.19- 0.31)。保守治疗每月访视率每单位的升高与4个预后较低的侵入性疗法几率相关。
Conclusion: PC consultation and a higher intensityof PC were associated with less aggressive care near death in patients withadvanced pancreatic cancer.
结论：在高级别胰腺癌接近死亡的患者中，保守治疗咨询和较高的强化保守治疗与较少的侵入性治疗相关。
原文链接：http://jnci.oxfordjournals.org/content/107/3/dju424.short
来源：JNCI J Natl Cancer Inst(2015)107 (3): dju424doi: 10.1093/jnci/dju424
本文由消化界翻译整理，转载请注明出处。
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