Predictors of Poor Prognosis in Patients with Malignant Ascites: A Prospective Study

Ayantunde, Abraham; Parsons, Simon L.

doi:10.5923/j.cmd.20120202.01

Cited by 8 publications

(9 citation statements)

References 14 publications

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“…We present very detailed characteristics of a cohort of 180 patients, and our results correlate with smaller prior studies 7,8,25,28–30 that show that ascites is a late manifestation of advanced pancreatic adenocarcinoma, and its presence carries an ominous prognosis, with observed mean OS in our cohort being 12 months (range, 10–14 months [95% CI]) from diagnosis and 1.8 months (range, 1.6–2.3 months [95%CI]) OS after ascites developed. Patients who presented with metastatic disease developed ascites 7 months following diagnosis.…”

Section: Discussionsupporting

confidence: 83%

“…Prior studies have evaluated malignant ascites in different types of cancers, 7,8,25,28–30 but very limited data exist on the prognostic importance of malignant ascites in pancreas adenocarcinoma. We present very detailed characteristics of a cohort of 180 patients, and our results correlate with smaller prior studies 7,8,25,28–30 that show that ascites is a late manifestation of advanced pancreatic adenocarcinoma, and its presence carries an ominous prognosis, with observed mean OS in our cohort being 12 months (range, 10–14 months [95% CI]) from diagnosis and 1.8 months (range, 1.6–2.3 months [95%CI]) OS after ascites developed.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, high levels of serum urea (> 6.5 mg/dL), creatinine (> 5.85 mg/dL), and total bilirubin (> 1.7 mg/dL) had worse overall survival in patients with malignant ascites. 7 An impaired performance status with Karnofsky index score ≤ 60 or Eastern Cooperative Oncology Group (ECOG) ≥ 2 was also correlated with inferior survival. 8 …”

Section: Introductionmentioning

confidence: 99%

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Pancreas Adenocarcinoma: Ascites, Clinical Manifestations, and Management Implications

Hicks

Chou

Capanu

et al. 2016

Clinical Colorectal Cancer

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This was a cohort analysis evaluating patients with pancreatic adenocarcinoma who presented with or developed ascites. Among the 180 patients analyzed, the use of serial paracenteses and indwelling catheters is a common practice to effect symptom palliation. The complication rate was higher in patients with indwelling catheters. Analyzing ascitic fluid and calculating the serum ascites albumin gradient can help attribute the etiology of the ascites and potentially identify which patients may benefit from diuretics or other intervention. Background Ascites develops in a subset of patients with pancreatic adenocarcinoma (PAC) at presentation or as the disease advances. Limited data exist on the prognostic importance of malignant ascites in PAC. Our hypothesis is that this information will provide an understanding of the natural history and facilitate management decisions. Methods We conducted a retrospective analysis of 180 patients treated at Memorial Sloan Kettering Cancer Center diagnosed between January 1, 2009 and December 31, 2014, with PAC and with ascites either at presentation or that developed during the disease course. Results For the 180 patients, the overall survival was 15 months. The time from diagnosis to ascites presentation was 11 months, and the survival time after ascites development was 1.8 months (range, 1.6–2.3 months; 95% confidence interval). Of 62 patients (34%) who had ascitic fluid analyzed, 36 (58%) had positive cytology. Fifty-one (82%) patients had a serum ascites albumin gradient ≥ 1, and 11 (18%) had serum ascites albumin gradient < 1. Sixty-four (36%) patients had their ascites managed solely by serial paracenteses. A total of 116 patients required a catheter; of these, 108 (93%) had a Tenckhoff catheter, 4 (3%) a Pleurx catheter, 4 (3%) a pigtail catheter, and 1 (1%) a Denver catheter. Eight (7%) patients required 2 catheters to be placed, and in 6 (5%), Tenckhoff catheters had to be removed. The main observed complications were spontaneous bacterial peritonitis in 7 (11%) managed with paracenteses versus 26 (23%) who had a catheter placed, catheter malfunction in 8 (7%), and acute renal failure in 6 (3%). After ascites development, 79 (44%) patients received active anti-cancer therapy, and 101 (56%) patients were managed with supportive care alone. Conclusions In patients with PAC who presented with or developed ascites, serial paracenteses and indwelling catheters are common methods used for providing symptomatic relief. The complication rate was higher with indwelling catheters, primarily related to infection (eg, bacterial peritonitis). Overall, ascites has a significantly negative prognostic import with a short median survival.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pancreas Adenocarcinoma: Ascites, Clinical Manifestations, and Management Implications

Hicks

Chou

Capanu

et al. 2016

Clinical Colorectal Cancer

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“…Other studies have reported similar associations between MRA and type of cancer; however, relative percentages and order of frequencies were different. 4,7 For example, in a retrospective study of 209 patients with cancer, MRA was most commonly seen in ovarian (38%), pancreaticobiliary (21%), gastric (18%), esophageal (4%), colorectal (4%), and breast (3%) cancer. 4 The greater proportion of female patients observed in our study was also seen in another smaller study that reported 140 (67%) females of 209 MRA hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

“…6 Although there are some studies evaluating the effects of clinical factors on hospital length of hospital stay and in-hospital mortality among a limited number of patients with MRA, detailed, large database, and epidemiological analyses are lacking, especially at the national level. 4,7,8 In this study, we tried to understand the epidemiology and inpatient hospital outcomes of patients with MRA in the United States using a national database.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Inpatient Hospital Outcomes of Malignancy-Related Ascites in the United States

Ramamoorthy

Rubens

Saxena

et al. 2020

Am J Hosp Palliat Care

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Objective: Malignancy-related ascites (MRA) is the terminal stage of many advanced cancers, and the treatment is mainly palliative. This study looked for epidemiology and inpatient hospital outcomes of patients with MRA in the United States using a national database. Methods: The current study was a cross-sectional analysis of 2015 National Inpatient Sample data and consisted of patients ≥18 years with MRA. Descriptive statistics were used for understanding demographics, clinical characteristics, and MRA hospitalization costs. Multivariate regression models were used to identify predictors of length of hospital stay and in-hospital mortality. Results: There were 123 410 MRA hospitalizations in 2015. The median length of stay was 4.7 days (interquartile range [IQR]: 2.5-8.6 days), median cost of hospitalization was US$43 543 (IQR: US$23 485-US$82 248), and in-hospital mortality rate was 8.8% (n = 10 855). Multivariate analyses showed that male sex, black race, and admission to medium and large hospitals were associated with increased hospital length of stay. Factors associated with higher in-hospital mortality rates included male sex; Asian or Pacific Islander race; beneficiaries of private insurance, Medicaid, and self-pay; patients residing in large central and small metro counties; nonelective admission type; and rural and urban nonteaching hospitals. Conclusions: Our study showed that many demographic, socioeconomic, health care, and geographic factors were associated with hospital length of stay and in-hospital mortality and may suggest disparities in quality of care. These factors could be targeted for preventing unplanned hospitalization, decreasing hospital length of stay, and lowering in-hospital mortality for this population.

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The Effect of Abdominal Massage in Reducing Malignant Ascites Symptoms

Wang

Yang

et al. 2014

Research in Nursing & Health

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As many as 50% of end-stage cancer patients will develop ascites and associated symptoms, including pain, tiredness, nausea, depression, anxiety, drowsiness, loss of appetite, dyspnea, perceived abdominal bloating, and immobility. Abdominal massage may stimulate lymph return to the venous system and reduce ascites-related symptoms. The purpose of this study was to test the effect of abdominal massage in reducing these symptoms and reducing ascites itself as reflected in body weight. For a randomized controlled design using repeated measures, a sample of 80 patients with malignant ascites was recruited from gastroenterology and oncology units of a medical center in northern Taiwan and randomly assigned to the intervention or the control group. A 15-minute gentle abdominal massage, using straight rubbing, point rubbing, and kneading, was administered twice daily for 3 days. The control group received a twice-daily 15-minute social interaction contact with the same nurse. Symptoms and body weight were measured in the morning for 4 consecutive days from pre- to post-test. In generalized estimation equation modeling, a significant group-by-time interaction on depression, anxiety, poor wellbeing, and perceived abdominal bloating, indicated that abdominal massage improved these four symptoms, with the greatest effect on perceived bloating. The intervention had no effect on pain, tiredness, nausea, drowsiness, poor appetite, shortness of breath, mobility limitation, or body weight. Abdominal massage appears useful for managing selected symptoms of malignant ascites.

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Predictors of Poor Prognosis in Patients with Malignant Ascites: A Prospective Study

Cited by 8 publications

References 14 publications

Pancreas Adenocarcinoma: Ascites, Clinical Manifestations, and Management Implications

Pancreas Adenocarcinoma: Ascites, Clinical Manifestations, and Management Implications

Prevalence and Inpatient Hospital Outcomes of Malignancy-Related Ascites in the United States

The Effect of Abdominal Massage in Reducing Malignant Ascites Symptoms

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