Admission of advanced lung cancer patients to intensive care unit: A retrospective study of 76 patients

<p>Abstract</p> <p>Background</p> <p>Criteria for admitting patients with incurable diseases to the medical intensive care unit (MICU) remain unclear and have ethical implications.</p> <p>Methods</p> <p>We retrospectively evaluated MICU outcomes and identified risk factors for MICU mortality in consecutive patients with advanced lung cancer admitted to two university-hospital MICUs in France between 1996 and 2006.</p> <p>Results</p> <p>Of 76 included patients, 49 had non-small cell lung cancer (stage IIIB n = 20; stage IV n = 29). In 60 patients, MICU admission was directly related to the lung cancer (complication of cancer management, n = 30; cancer progression, n = 14; and lung-cancer-induced diseases, n = 17). Mechanical ventilation was required during the MICU stay in 57 patients. Thirty-six (47.4%) patients died in the MICU. Three factors were independently associated with MICU mortality: use of vasoactive agents (odds ratio [OR] 6.81 95% confidence interval [95%CI] [1.77-26.26], p = 0.005), mechanical ventilation (OR 6.61 95%CI [1.44-30.5], p = 0.015) and thrombocytopenia (OR 5.13; 95%CI [1.17-22.5], p = 0.030). In contrast, mortality was lower in patients admitted for a complication of cancer management (OR 0.206; 95%CI [0.058-0.738], p = 0.015). Of the 27 patients who returned home, four received specific lung cancer treatment after the MICU stay.</p> <p>Conclusions</p> <p>Patients with acute complications of treatment for advanced lung cancer may benefit from MCIU admission. Further studies are necessary to assess outcomes such as quality of life after MICU discharge.</p

Wound-induced tumor progression - A probable role in recurrence after tumor resection

Objective: To determine the effect of several wound factors on melanoma growth in a mouse model. Design: Cohort analytic study. Setting: Animal research facility of Roger Williams Medical Center, Providence, RI. Study Group: Seventeen groups of 5 C57BL/6 mice each. Interventions: A surgical wound was created in 1 hind limb, after which different concentrations of B16F10 melanoma cells were injected in adjacent subcutaneous tissue. The nonwounded hind limb in the same mouse served as a control. In this fashion, a critical tumor cell dose was determined that showed tumor growth in the wounded but not the control hind limb. Tumor growth in control hind limbs then was compared with that in the "artificially wounded" hind limbs, which were co-injected with mouse wound fluid or growth factors. Early (day 1) and late (day 10) wound fluids and tumor growth factor beta (TGF-beta), basic fibroblast growth factor (bFGF), both combined, and interleukin 6 (IL-6) were used. Main Outcome Measure: Wound factors increase tumor growth, indicating potentiation of tumor recurrence at a surgical wound. Results: The critical tumor cell dose was 103 cells. All growth factors and both wound fluids showed increased tumor growth over time except IL-6. Hind limbs injected with early wound fluid showed increased tumor growth over time when compared with those injected with late wound fluid (P Conclusions: The healing wound and its mediators in wound fluid or purified growth factors significantly enhanced tumor growth. Combining TGF-beta and bFGF increased tumor growth to a level closer to wound fluid. The inflammatory response provoked by wound healing mediators may be an important mechanism in tumor growth after ablative surgery

Wound-induced tumor progression - A probable role in recurrence after tumor resection

Objective: To determine the effect of several wound factors on melanoma growth in a mouse model. Design: Cohort analytic study. Setting: Animal research facility of Roger Williams Medical Center, Providence, RI. Study Group: Seventeen groups of 5 C57BL/6 mice each. Interventions: A surgical wound was created in 1 hind limb, after which different concentrations of B16F10 melanoma cells were injected in adjacent subcutaneous tissue. The nonwounded hind limb in the same mouse served as a control. In this fashion, a critical tumor cell dose was determined that showed tumor growth in the wounded but not the control hind limb. Tumor growth in control hind limbs then was compared with that in the "artificially wounded" hind limbs, which were co-injected with mouse wound fluid or growth factors. Early (day 1) and late (day 10) wound fluids and tumor growth factor beta (TGF-beta), basic fibroblast growth factor (bFGF), both combined, and interleukin 6 (IL-6) were used. Main Outcome Measure: Wound factors increase tumor growth, indicating potentiation of tumor recurrence at a surgical wound. Results: The critical tumor cell dose was 103 cells. All growth factors and both wound fluids showed increased tumor growth over time except IL-6. Hind limbs injected with early wound fluid showed increased tumor growth over time when compared with those injected with late wound fluid (P Conclusions: The healing wound and its mediators in wound fluid or purified growth factors significantly enhanced tumor growth. Combining TGF-beta and bFGF increased tumor growth to a level closer to wound fluid. The inflammatory response provoked by wound healing mediators may be an important mechanism in tumor growth after ablative surgery

Wound-induced tumor progression - A probable role in recurrence after tumor resection

Objective: To determine the effect of several wound factors on melanoma growth in a mouse model. Design: Cohort analytic study. Setting: Animal research facility of Roger Williams Medical Center, Providence, RI. Study Group: Seventeen groups of 5 C57BL/6 mice each. Interventions: A surgical wound was created in 1 hind limb, after which different concentrations of B16F10 melanoma cells were injected in adjacent subcutaneous tissue. The nonwounded hind limb in the same mouse served as a control. In this fashion, a critical tumor cell dose was determined that showed tumor growth in the wounded but not the control hind limb. Tumor growth in control hind limbs then was compared with that in the "artificially wounded" hind limbs, which were co-injected with mouse wound fluid or growth factors. Early (day 1) and late (day 10) wound fluids and tumor growth factor beta (TGF-beta), basic fibroblast growth factor (bFGF), both combined, and interleukin 6 (IL-6) were used. Main Outcome Measure: Wound factors increase tumor growth, indicating potentiation of tumor recurrence at a surgical wound. Results: The critical tumor cell dose was 103 cells. All growth factors and both wound fluids showed increased tumor growth over time except IL-6. Hind limbs injected with early wound fluid showed increased tumor growth over time when compared with those injected with late wound fluid (P Conclusions: The healing wound and its mediators in wound fluid or purified growth factors significantly enhanced tumor growth. Combining TGF-beta and bFGF increased tumor growth to a level closer to wound fluid. The inflammatory response provoked by wound healing mediators may be an important mechanism in tumor growth after ablative surgery

Wound-induced tumor progression - A probable role in recurrence after tumor resection

Objective: To determine the effect of several wound factors on melanoma growth in a mouse model. Design: Cohort analytic study. Setting: Animal research facility of Roger Williams Medical Center, Providence, RI. Study Group: Seventeen groups of 5 C57BL/6 mice each. Interventions: A surgical wound was created in 1 hind limb, after which different concentrations of B16F10 melanoma cells were injected in adjacent subcutaneous tissue. The nonwounded hind limb in the same mouse served as a control. In this fashion, a critical tumor cell dose was determined that showed tumor growth in the wounded but not the control hind limb. Tumor growth in control hind limbs then was compared with that in the "artificially wounded" hind limbs, which were co-injected with mouse wound fluid or growth factors. Early (day 1) and late (day 10) wound fluids and tumor growth factor beta (TGF-beta), basic fibroblast growth factor (bFGF), both combined, and interleukin 6 (IL-6) were used. Main Outcome Measure: Wound factors increase tumor growth, indicating potentiation of tumor recurrence at a surgical wound. Results: The critical tumor cell dose was 103 cells. All growth factors and both wound fluids showed increased tumor growth over time except IL-6. Hind limbs injected with early wound fluid showed increased tumor growth over time when compared with those injected with late wound fluid (P Conclusions: The healing wound and its mediators in wound fluid or purified growth factors significantly enhanced tumor growth. Combining TGF-beta and bFGF increased tumor growth to a level closer to wound fluid. The inflammatory response provoked by wound healing mediators may be an important mechanism in tumor growth after ablative surgery

The effect of surgical wounding on tumour development

For more than a century, a role for wound healing in the outgrowth of tumours has been implied based on observations in both experimental and clinical studies. Wound healing can be divided into stages of inflammatory, proliferative, repair and remodelling processes. Through proper regulation of activation of epithelial, endothelial and inflammatory cells, platelets and fibroblasts, and the production of growth factors, wounds heal and the various cell types resume their normal function, In tumour growth, similar processes of cell activation and growth factor production are observed. These processes are, however, differently regulated leading to ongoing cellular activation. In recent years, growth factors such as EGF, TGF-alpha and TGF-beta, bFGF, IGF I and II, and PDGF have been identified to play a role in the different stages of wound healing. In addition, some of these factors have now been identified as also being involved in the outgrowth of tumours, In this review, cell types involved in wound healing and tumour growth, as well as the growth factors and cytokines they produce and the role of the extracellular matrix, extensively present in both conditions, are being discussed. A better understanding of the time interval during which the sequelae of events in wound healing occur in relation to the time interval of tumour recurrence may be the basis for defining new therapeutic strategies that can interfere with tumour outgrowth without affecting wound healing processes, These new therapeutic approaches may be of importance especially after surgery or other invasive (diagnostic) procedures in cancer patients