Viganò A, Dorgan M, Buckingham J, Bruera E, Suarez-Almazor M E
Division of Palliative Care Medicine, University of Alberta, Edmonton, Canada.
Palliat Med. 2000 Sep;14(5):363-74. doi: 10.1191/026921600701536192.
The clinical significance of studies on survival predictors in terminal cancer patients is hindered by both methodological limitations and the difficulty of finding common predictors for all final events in cancer related deaths. To evaluate the published medical literature concerned with the survival of patients with terminal cancer and identify potential prognostic factors, major electronic databases including MEDLINE (1966-), CANCERLIT (1983-) and EMBASE (1988-) were searched up to September 1999. Studies were included in our review if published in English, were cohort studies, addressed the identification of clinical prognostic factors for survival and looked at samples with median survival of < or = 3 months. Data extracted from selected papers included: sample size, median survival, type of study, sampling frame, cohort type, type of statistical analysis (univariate or multivariate), choice of models and underlying assumptions, predictors examined and their reported level of statistical significance. A total of 24 studies were found and reviewed. On the basis of these studies, performance status and the presence of cognitive failure, weight loss, dysphagia, anorexia and dyspnoea appear to be independent survival predictors in this population. Clinical estimation of survival by the treating physician appeared independently associated with survival but the magnitude of the association generally appeared small. Clinical predictions should be considered as one of many criteria, rather than as a unique criterion by which to choose therapeutic interventions or health care programmes for terminally ill cancer patients. The use of convenient samples as opposed to more representative inception cohorts, the inclusion of different variables in the statistical analyses and inappropriate statistical methods appear to be major limitations of the reviewed literature. Methodological improvements in the design and conduction of future studies may reduce the prognostic uncertainty in this population.
对晚期癌症患者生存预测因素的研究，其临床意义受到方法学局限性以及难以找到癌症相关死亡所有最终事件的共同预测因素的阻碍。为了评估已发表的有关晚期癌症患者生存情况的医学文献并确定潜在的预后因素，检索了包括MEDLINE（1966年起）、CANCERLIT（1983年起）和EMBASE（1988年起）在内的主要电子数据库，截至1999年9月。如果研究以英文发表、属于队列研究、涉及生存临床预后因素的识别且观察对象的中位生存期≤3个月，则纳入本综述。从选定论文中提取的数据包括：样本量、中位生存期、研究类型、抽样框架、队列类型、统计分析类型（单变量或多变量）、模型选择及潜在假设、所检验的预测因素及其报告的统计学显著性水平。共找到并综述了24项研究。基于这些研究，体能状态以及认知功能障碍、体重减轻、吞咽困难、厌食和呼吸困难的存在似乎是该人群独立的生存预测因素。主治医生对生存的临床估计似乎与生存独立相关，但这种关联程度通常较小。临床预测应被视为众多标准之一，而非为晚期癌症患者选择治疗干预措施或医疗保健方案的唯一标准。与更具代表性的起始队列相比，使用方便样本、统计分析中纳入不同变量以及不恰当的统计方法似乎是所综述文献的主要局限性。未来研究在设计和实施方面的方法学改进可能会降低该人群预后的不确定性。
