系統的抗がん療法 (CAVA) の提供のための中央静脈アクセス装置: ランダム化制御試験
Jonathan G Moss1, Olivia Wu2, Andrew R Bodenham3
1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Lancet (London, England)
|July 23, 2021
まとめ
完全に植入されたポート (PORT) は,ヒックマン型トンネル型カテーテル (Hickman) や周辺に挿入された中央カテーテル (PICC) よりも,全身がん治療 (SACT) の提供に安全で効果的です. これらの発見は,英国の患者でPORTのSACTの使用を支持します.
科学分野:
- 腫瘍学
- 医療機器
- 臨床試験
背景:
- ヒックマン型トンネル型カテーテル (Hickman),周辺に挿入された中央カテーテル (PICC) および完全に埋め込まれたポート (PORT) は,全身がん治療 (SACT) で使用される中央静脈アクセス装置です.
- これらの器具の合併症率とコストを比較することは,SACTの投与における臨床的効果と費用対効果を決定するために極めて重要です.
研究 の 目的:
- Hickman,PICC,PORTの合併症率と費用をSACTを受けた患者と比較する.
- これらの3つの中央静脈アクセス装置の許容性,臨床的有効性,および費用対効果を確立する.
主な方法:
- イギリスの18の腫瘍科でSACTを投与された成人を対象としたオープン・マルチセンター・ランダム化対照試験 (CAVA)
- PICCとHickman (劣等感がない),PORTとHickman (優等感),PORTとPICC (優等感) の3つの比較が行われました.
- 主なアウトカムは,装置の除去,試験終了,または1年間の追跡まで評価された合併症率でした.
主要な成果:
- PICC (52%) とHickman (49%) の間でも同様の合併症率が観察され,PICCは劣らないと確認されなかった.
- PORTはヒックマンと比較して優れた安全性と有効性を示した (29%対43%の合併症率).
- PORTはPICCよりも優れており,合併症率が低い (32%対47%).
結論:
- 完全に埋め込まれたポート (PORT) は,SACTを投与する患者の大半にとって,ヒックマンとPICCよりも効果的で安全です.
- この発見は,PORTが英国の国立保健サービスにおけるSACT投与のための好ましい中央静脈アクセス装置であるべきであることを強く示唆しています.
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