摘要

目的：隨著癌症治療進步，病人生存期雖延長但營養不良仍顯著影響療效與生活品質。惡病質 (cachexia) 於末期癌症病人常見，約佔20% 癌症死亡。居家靜脈營養(home parenteral nutrition, HPN) 或可改善症狀、延長存活期，但適用性仍需研究。本研究以回溯性分析探討HPN 對末期癌症病人生存的影響，並辨識預測因子，協助臨床篩選適合HPN 的病人。

方法：本研究納入2010 至2024 年間共410 名末期癌症病人，依1:1 分為HPN組（連續使用HPN ≥ 7 天，205 人）及對照組（僅安寧照護，205 人）。收集病人基本、臨床及存活資料，並採Cox 比例風險模型及Kaplan– Meier 分析評估HPN 效益。

結果：HPN 組中位存活為77 天，對照組17 天，p < 0.001。多變項分析顯示：Eastern Cooperative Oncology Group performance status (ECOG PS) > 2 (hazard ratio [HR]= 1.664, 95% confidence interval [CI]: 1.305–2.122, p < 0.001)、簽署DNR（HR

= 1.714, 95% CI:1.291– 2.274, p < 0.001）及低血清白蛋白（HR = 0.826, 95% CI: 0.689–0.989, p = 0.038）均預測較高死亡風險；HPN 使用量增加則降低死亡風險（HR = 0.988, 95% CI: 0.985– 0.991, p < 0.001）。

結論：HPN 可延長末期癌症病人生存，特別適用於年輕、ECOG PS 較佳且接受積極治療者。ECOG PS > 2 與低血清白蛋白為獨立預後因子，應納入臨床決策。HPN 能提升病人精力與生活品質，助其完成心願，但伴隨行動及社交限制，需審慎評估。病人應擁有選擇HPN 的權利，在最後階段獲得最符合自身期望的照護。

 

ABSTRACT

Objective: Despite prolonged survival from advancements in cancer treatment, malnutrition remains a critical issue, impacting outcomes and quality of life. Cachexia, present in terminal-stage cancer and accounting for about 20% of cancer deaths, may be alleviated by home parenteral nutrition (HPN). This retrospective study examined the impact of HPN on survival in terminal-stage cancer and identified prognostic factors to guide clinical selection.

Methods: Between 2010 and 2024, 410 terminal-stage cancer patients were enrolled and divided 1:1 into an HPN group (≥ 7 consecutive days, n = 205) and controls receiving only hospice care (n = 205). Baseline, clinical, and survival data were collected and analyzed via Cox proportional hazards and Kaplan–Meier methods.

Results: The HPN group had a median survival of 77 days versus 17 days in controls, p < 0.001. Multivariate analyses showed that Eastern Cooperative Oncology Group performance status (ECOG PS) > 2 (hazard ratio [HR] = 1.664, 95% confidence interval [CI]:1.305–2.122, p < 0.001), signed DNR (HR = 1.714, 95% CI:1.291– 2.274, p < 0.001), and low albumin (HR = 0.826, 95% CI: 0.689–0.989, p = 0.038) predicted higher mortality, while increased HPN usage lowered mortality risk (HR = 0.988, 95% CI:0.985–0.991, p < 0.001).

Conclusions: HPN prolongs survival in terminal-stage cancer, particularly in younger patients with better ECOG PS who continue active treatment. ECOG PS > 2 and hypoalbuminemia remain independent prognostic factors requiring clinical consideration. Although HPN can enhance energy and quality of life— enabling some to fulfill personal goals—mobility and social limitations necessitate careful assessment. Patients should have the right to choose HPN, aligning end-of-life care with their own preferences.

 

 

Submitted for publication: 2025.02.08; Accepted for publication: 2025.06.09