Dados do Trabalho

Título

RETROSPECTIVE ANALYSIS OF SURVIVAL AND PROGNOSTIC FACTORS OF PATIENTS WITH ADVANCED PANCREATIC ADENOCARCINOMA ADMITTED TO AN INTENSIVE CARE UNIT DUE TO CLINICAL COMPLICATIONS

Introdução

Pancreatic cancer is very aggressive neoplasms and few patients with advanced disease are able to undergo more than one line of treatment. In this study, we evaluated the real clinical benefit of referring patients with advanced pancreatic adenocarcinoma to the intensive care unit (ICU) due to clinical causes, evaluating the overall survival after 30 days of UCI admission.

Objetivo

The main objective of this study is to describe the survival outcomes of patients with locally advanced or metastatic pancreatic adenocarcinoma admitted for clinical causes in the ICU. The secondary objective is to identify prognostic factors associated with a higher probability of survival 30 days after the UCI admission.

Método

This is a retrospective cohort that included all patients with advanced pancreatic adenocarcinoma, diagnosed from January 2009 to December 2018, who had their first clinical admission to the AC Camargo Cancer Center ICU (São Paulo, Brazil). Demographic and clinicopathological data were collected from electronic medical records. The predictors of survival 30 days after admission to the ICU were evaluated using univariate and multivariate logistic regression models. The unit of analysis of the study is the patient, being analyzed only the first hospitalization of the patient.

Resultado

Among the 172 patients analyzed, the median age was 65.5 years, 50.6% were men and liver metastasis was the most common site of metastasis, present in 60.5% of the patients. 54.7% had ECOG 2-4. The median duration of ICU stay was 4 days, with 40.1% requiring vasoactive drugs and 18.6% requiring mechanical ventilation. The most common cause of hospitalization was sepsis, corresponding to 49.4%, and the biliary site represented 22.7%. After a median follow-up of 1162 days, the median overall survival was 32 days. In the multivariate model, ECOG 2-4, presence of hepatic metastasis, admission due to cardiovascular or cerebrovascular causes, and higher respiratory SOFA were associated with lower chances of being alive 30 days after the UCI admission.

Conclusão

As expected, the OS of these patients is short, with ECOG 2-4, liver metastases, respiratory SOFA, and cardiovascular and cerebrovascular events as the main predictors of poor prognosis and shorter 30-day survival.

Palavras-chave

advanced pancreatic adenocarcinoma; metastatic pancreatic adenocarcinoma; intensive care unit; clinical causes