在免疫治疗中突破了高级HCC患者重症监护入院的障碍
Marta Fortuny1,2,3, Leonardo G da Fonseca4, Manon Allaire5
1Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona Clinic Liver Cancer (BCLC) Group, Barcelona, Spain.
概括
接受免疫检查点抑制剂 (ICI) 治疗的晚期肝细胞癌 (HCC) 患者进入重症监护室 (ICU) 往往是由于与免疫相关的不良事件 (irAEs). 尽管如此,许多人幸存下来并可以恢复治疗,这凸显了重症监护的价值.
科学领域:
- 在瘤学瘤学.
- 关键护理医学 关键护理医学
- 免疫治疗是一种免疫疗法.
背景情况:
- 晚期肝细胞癌 (HCC) 患者由于预后不佳,经常被拒绝进入重症监护室 (ICU).
- 免疫检查点抑制剂 (ICI) 改善了HCC的治疗结果.
- 关键护理对于管理与ICI相关的不良事件越来越重要.
研究的目的:
- 评估接受ICI治疗的高级HCC患者的结局,这些患者被录入ICU.
- 评估重症监护对这一患者群体的生存和治疗延续的影响.
主要方法:
- 在20个医疗中心 (2012年11月 - 2024年4月) 接受ICI组合治疗的1065名患者的全球队列研究.
- 收集的数据包括人口统计,ICI类型,ICU入院原因,器官支持和短期/中期死亡率.
- 分析的重点是接受ICU治疗的患者,特别是那些患有免疫相关不良事件 (irAEs) 的患者.
主要成果:
- 4.4%的患者 (47/1065) 住院于ICU,主要是由于irrAEs (46.8%) 或水出血 (29.8%).
- 集中治疗室死亡率为25.5%,但66%的患者活着出院,3个月和6个月的生存率分别为83%和69%.
- 超过60%的幸存者恢复了ICI治疗或开始新的HCC治疗.
结论:
- 免疫相关的不良事件是ICU治疗中高级HCC患者ICU入院的重要原因.
- 尽管病情危急,但这些患者中有很大一部分在ICU住院后幸存下来,可以继续癌症治疗.
- 这些发现支持了ICU护理对接受ICI的高级HCC患者的关键作用,挑战了以前的排除标准.
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