Analysis of Use and Outcomes of Peripherally Inserted Central Catheter (PICC-Line) in Hemato-Oncological Patients

Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rate of complications in PICC line;studying the cause of early removal of PICC line. Methods: All PICCs inserted in adult hemato-oncological patients in Hematology and Medical Oncology Department of Health Care Global (HCG) Hospital were studied prospectively, as per the proforma, till PICCs were removed or patient expired and the pattern of complications were noted. Results: Eighty-four PICCs were inserted over a period of initial nine months and followed for a total of 1 year with three months post insertion duration for a total of 10,868 catheter-days (mean of 129 days i.e. 4.3 months, range: 1 to 288 days). The most common indication for PICC was chemotherapy (100%). Among them 19 (22%) PICCs had complications and 12 were removed at the rate of 1.1/1000 PICC-days. Complications with haematologic malignancies were more as compared to those with solid tissue malignancies. Conclusions: Despite significant complication rates, PICCs are a relatively safe and cost effective mode of establishing central venous access.

健脾活血中药联合化疗治疗大肠癌术后患者临床观察

目的:观察健脾活血中药联合化疗在大肠癌术后治疗中的临床疗效。方法:选择76例大肠癌术后患者为研究对象,以随机数字表法分为2组各38例,对照组单纯采用化疗治疗,观察组采用健脾活血中药联合化疗治疗,对2组患者生存状态、生活质量、不良反应发生情况等进行观察。结果:观察组患者6月死亡率15.79%,中位生存时间(26.12±5.18)月,对照组患者6月死亡率39.47%,中位生存时间(20.67±8.44)月,2组死亡率、中位生存时间分别比较,差异均有统计学意义(P<0.01);治疗后,观察组Karnofsky评分较对照组高,美国中部肿瘤协作组(ECOG)评分较对照组低,差异均有统计学意义(P<0.01);观察组治疗后不良反应程度低于对照组,差异有统计学意义(P<0.05)。结论:健脾活血中药配合化疗可延长大肠癌患者术后生存时间,也能减轻化疗不良反应,对提高患者生活质量具有重要作用。

Prognostic value of ECOG performance status and Gleason score in the survival of castration-resistant prostate cancer:a systematic review

Eastern Cooperative Oncology Group(ECOG)performance status and Gleason score are commonly investigated factors for overall survival(OS)in men with castration-resistant prostate cancer(CRPC).However,there is a lack of consistency regarding their prognostic or predictive value for OS.Therefore,we performed this meta-analysis to assess the associations of ECOG performance status and Gleason score with OS in CRPC patients and compare the two markers in patients under different treatment regimens or with different chemotherapy histories.A systematic literature review of monotherapy studies in CRPC patients was conducted in the PubMed database until May 2019.The data from 8247 patients in 34 studies,including clinical trials and real-world data,were included in our meta-analysis.Of these,twenty studies reported multivariate results and were included in our main analysis.CRPC patients with higher ECOG performance statuses(≥2)had a significantly increased mortality risk than those with lower ECOG performance statuses(<2),hazard ratio(HR):2.10,95%confidence interval(CI):1.68-2.62,and P<0.001.The synthesized HR of OS stratified by Gleason score was 1.01,with a 95%CI of 0.62-1.67(Gleason score≥8 vs<8).Subgroup analysis showed that there was no significant difference in pooled HRs for patients administered taxane chemotherapy(docetaxel and cabazitaxel)and androgen-targeting therapy(abiraterone acetate and enzalutamide)or for patients with different chemotherapy histories.ECOG performance status was identified as a significant prognostic factor in CRPC patients,while Gleason score showed a weak prognostic value for OS based on the available data in our meta-analysis.

Interconversion of two commonly used performance tools: An analysis of 5844 paired assessments in 1501 lung cancer patients

AIM To establish the Karnofsky performance status(KPS) categories which would facilitate the interconversion of the KPS scale to the Eastern Cooperative Oncology Group(ECOG) performance status(PS) scale.METHODS This was a retrospective analysis of all patients attending the lung cancer clinic at a tertiary care center over a 5-year period(September 2009 to August 2014). All patients were assessed with both KPS and ECOG PS scales at each visit. Correlation between KPS and ECOG PS was assessed using Spearman's correlation coefficient. KPS categories equivalent to ECOG PS scores were compared using hit rate and weighted kappa(κw).RESULTS A total of 1501 patients were assessed over the study period, providing 5844 paired KPS and ECOG PS assessments. The study cohort had a mean(standard deviation; SD) age of 58.4(10.8) years, with the majority being current or ex-smokers(76.9%) and males(82.3%). Non-small cell lung cancer was the most common histological type(n = 1196, 79.7%) with the majority having advanced(stage ⅢB/Ⅳ) disease(83.4%). Mean baseline KPS and ECOG PS scores were 77.6(SD = 14.4) and 1.5(SD = 1) respectively. The most frequent KPS score was 80(29%), and the most frequent ECOG PS score was 1(43%). The overall correlation between KPS and ECOG PS was good(Spearman r =-0.84, P < 0.0001) but ranged from-0.727 to-0.972 between visits. KPS categories derived from our cohort [10-40(ECOG 4), 50-60(ECOG 3), 70(ECOG 2), 80-90(ECOG 1), 100(ECOG 0)] performed better [hit rate 78.1%, κw = 0.749(0.736-0.762) P < 0.0001] than those suggested in the past literature.CONCLUSION The current study provides the largest set of paired KPS-ECOG assessments to date. We suggest that the KPS categories 10-40, 50-60, 70, 80-90, and 100 are equivalent to ECOG PS categories of 4, 3, 2, 1, and 0 respectively.

老年非霍奇金淋巴瘤患者老年综合评估评分的比较研究

目的提供老年非霍奇金淋巴瘤（NHL）患者老年综合评估（CGA）评分的分布数据；对比美国东部肿瘤协作组（ECOG）体力状况评分与CGA评分的差异。方法将北京医院血液科2014年2月至2017年2月收治的≥60岁NHL患者进行CGA评分，包括日常生活活动功能评定量表（ADL）、工具性日常生活活动功能评估量表（IADL）和改良老年疾病累计评分表（MCIRS-G），依据量表得分及年龄将患者分为适合组、不适合组和脆弱组。采用横断面研究，了解其临床特征，分析CGA评分分布，并对比ECOG体力状况评分与CGA评分的差异。结果64例老年NHL患者纳入研究。根据CGA评估，适合组占51.6%（33例），不适合组占12.5%（8例），脆弱组占35.9%（23例）；大多数患者有合并症，其中心血管疾病、糖尿病、高血压病较为常见；在60~64岁较年轻的患者中仍有25%（3/12）的患者CGA评估为＂脆弱＂，在≥80岁的高龄患者中＂脆弱＂比例达42.9%（6/14）；ECOG体力状况评分≤1分的患者中仍有38.9%（21/54）存在CGA受损。结论依据CGA评估，60岁及以上NHL患者中近一半存在CGA受损；在ECOG体力状况评分≤1分的患者中仍有部分患者存在CGA受损，提示ECOG评分会低估老年NHL患者功能受损程度。