Retrospektive Analyse von Diagnostik, Klinik und Verlauf bei Patienten mit Vena-cava-superior-Syndrom (obere Einflussstauung)

Abstract

Superior vena cava syndrome (SVCS) is caused by a compression of the superior vena cava and represents an important oncologic emergency. The aim of this retrospective study was to investigate if there are differences in diagnosis, clinical features, course and outcome in patients with SVCS depending on whether a patient was admitted and treated on a weekday or at a weekend at the University Hospital in Göttingen due to different staff resources. 124 patients were identified with SVCS caused by malignancy from the hospital’s database for the years 1992 to 2011 and they were separated into two groups depending on their admission day. Among the 124 cases, the following entities led to SVCS: small cell lung cancer (SCLC) in 28,2%, non-small cell lung cancer (NSCLC) in 25,0%, non-Hodgkin’s lymphoma (NHL) in 25,0%, metastases of other malignant tumors in 19,4% and Hodgkin's disease in 2,4% of all cases. Ten of these patients had a recurrence of a previous malignant disease. In all patients in whom malignant cause of the present SVCS was not yet known an emergency histology was done and subsequently a treatment decision was made. The histology and treatment decision were made regardless of whether the patient had been taken to the hospital on a weekday or at the weekend. None of the patients in this study died due to SVCS. The analysis showed that the difference in mortality rates between patients of the weekday group (12.3%) and weekend group (11.6%) was minimal. There was also no difference found in choice of treatment (chemotherapy, radiation, radiochemotherapy, palliative treatment or no treatment) between the two groups. Apart from the comparison of the above groups, the study also found that relapsed patients had a worse outcome compared to the other patients. The same was seen in patients for whom no emergency histology was done and in which the underlying malignant disease was already known at admission to the hospital with SVCS. Furthermore, a comparison of the response rates of malignant entities and their treatment modalities described in the literature with the ones of patients in this study who also suffered from SVCS was undertaken. It showed that lower remission rates were achieved in patients with SVCS.