Background:The intersection between oncology and intensive care has shifted from predominantly end-of-life care to a therapeutic bridge that can preserve anticancer trajectories in carefully selected patients. Yet, criteria separating benefit from futility remain fragmented.Objective:This paper seeks to map contemporary evidence (2015–2025) on outcomes after Intensive Care Unit (ICU) admission in adults with cancer and to identify clinical constellations in which ICU-level care still changes prognosis.Methods:PRISMA-ScR scoping review (PCC framework). PubMed search (2015–2025), dual screening, standardized extraction; narrative/thematic synthesis across six clusters (hematologic, solid tumors, sepsis/non-COVID-19 infection, COVID-19/viral pneumonia, novel/targeted-therapy toxicities, end-of-life/aggressive ICU) were used. No meta-analysis given heterogeneity.Results:Seventy-three studies (>170,000 ICU admissions) were included, mostly cohort designs across 27 countries. ICU mortality ranged 8–72% (weighted mean ≈ 41%); hospital ≈ 38%; 90-day ≈ 46%; 1-year ≈ 62%. About one third of ICU survivors resumed systemic therapy. Benefit concentrated in early admissions, single-organ failure, controlled/remission disease, postoperative/elective monitoring, and reversible treatment-related toxicities (e.g., ICI pneumonitis, CAR-T CRS/ICANS). Futility clustered around ≥3 organ supports, RRT > 7 days, refractory/progressive disease, and ECOG ≥ 3. Sepsis outcomes averaged 45–55% ICU mortality but improved with rapid recognition and source control; COVID-19 mortality was particularly high in hematologic malignancies early in the pandemic, with subsequent declines post-vaccination.Conclusions:In modern oncologic practice, ICU care changes prognosis when the acute physiological insult is reversible and cancer control remains plausible; conversely, high organ-support burden and refractory disease define practical futility thresholds. These signals support time-limited ICU trials, earlier ICU involvement for sepsis/irAEs, and embedded palliative care to align intensity with goals.
背景：肿瘤学与重症监护的交汇点已从以临终关怀为主，转变为一种治疗桥梁，可在精心筛选的患者中维持抗癌治疗路径。然而，区分获益与无效的标准仍不统一。 目的：本文旨在梳理2015年至2025年间关于成年癌症患者入住重症监护病房（ICU）后结局的现有证据，并识别ICU级别照护仍能改变预后的临床情况。 方法：采用PRISMA-ScR范围综述方法（PCC框架）。检索PubMed（2015–2025年），进行双重筛选和标准化数据提取；对六大类别（血液肿瘤、实体瘤、脓毒症/非COVID-19感染、COVID-19/病毒性肺炎、新型/靶向治疗毒性、临终/激进ICU治疗）进行叙述性/主题性综合。鉴于异质性，未进行荟萃分析。 结果：共纳入73项研究（涉及>17万例ICU入院），主要为来自27个国家的队列研究。ICU死亡率范围为8%–72%（加权平均值≈41%）；医院死亡率≈38%；90天死亡率≈46%；1年死亡率≈62%。约三分之一的ICU幸存者恢复了全身性治疗。获益主要集中在早期入住、单器官衰竭、疾病控制/缓解、术后/择期监测以及可逆的治疗相关毒性（如免疫检查点抑制剂肺炎、CAR-T细胞因子释放综合征/免疫效应细胞相关神经毒性综合征）的患者中。无效治疗则多集中于≥3种器官支持、持续肾脏替代治疗>7天、难治性/进展性疾病以及ECOG评分≥3的情况。脓毒症患者的ICU死亡率平均为45%–55%，但通过快速识别和感染源控制可改善预后；COVID-19死亡率在疫情早期的血液系统恶性肿瘤患者中尤其高，疫苗接种后有所下降。 结论：在现代肿瘤临床实践中，当急性生理损伤可逆且癌症控制仍有可能时，ICU照护可改变预后；反之，高器官支持负担和难治性疾病界定了实际的无效治疗阈值。这些证据支持进行有时限的ICU试验、对脓毒症/免疫相关不良事件更早启动ICU干预，以及整合姑息治疗以使治疗强度与目标相一致。
肿瘤(癌症)患者之家