Maltoni Marco, Caraceni Augusto, Brunelli Cinzia, Broeckaert Bert, Christakis Nicholas, Eychmueller Steffen, Glare Paul, Nabal Maria, Viganò Antonio, Larkin Philip, De Conno Franco, Hanks Geoffrey, Kaasa Stein
Palliative Care Unit, Department of Medical Oncology, Morgagni-Pierantoni Hospital, Via Forlanini, 34, 47100 Forlì, Italy.
J Clin Oncol. 2005 Sep 1;23(25):6240-8. doi: 10.1200/JCO.2005.06.866.
To offer evidence-based clinical recommendations concerning prognosis in advanced cancer patients.
A Working Group of the Research Network of the European Association for Palliative Care identified clinically significant topics, reviewed the studies, and assigned the level of evidence. A formal meta-analysis was not feasible because of the heterogeneity of published studies and the lack of minimal standards in reporting results. A systematic electronic literature search within the main available medical literature databases was performed for each of the following four areas identified: clinical prediction of survival (CPS), biologic factors, clinical signs and symptoms and psychosocial variables, and prognostic scores. Only studies on patients with advanced cancer and survival < or = 90 days were included.
A total of 38 studies were evaluated. Level A evidence-based recommendations of prognostic correlation could be formulated for CPS (albeit with a series of limitations of which clinicians must be aware) and prognostic scores. Recommendations on the use of other prognostic factors, such as performance status, symptoms associated with cancer anorexia-cachexia syndrome (weight loss, anorexia, dysphagia, and xerostomia), dyspnea, delirium, and some biologic factors (leukocytosis, lymphocytopenia, and C-reactive protein), reached level B.
Prognostication of life expectancy is a significant clinical commitment for clinicians involved in oncology and palliative care. More accurate prognostication is feasible and can be achieved by combining clinical experience and evidence from the literature. Using and communicating prognostic information should be part of a multidisciplinary palliative care approach.
提供关于晚期癌症患者预后的循证临床建议。
欧洲姑息治疗协会研究网络的一个工作组确定了具有临床意义的主题，对研究进行了综述，并确定了证据水平。由于已发表研究的异质性以及报告结果缺乏最低标准，因此无法进行正式的荟萃分析。针对以下四个确定的领域，在主要可用医学文献数据库中进行了系统的电子文献检索：生存的临床预测（CPS）、生物学因素、临床体征和症状以及心理社会变量，以及预后评分。仅纳入了关于晚期癌症患者且生存期≤90天的研究。
共评估了38项研究。可以针对CPS（尽管存在一系列临床医生必须知晓的局限性）和预后评分制定基于A类证据的预后相关性建议。关于使用其他预后因素的建议，如体能状态、与癌症恶病质综合征相关的症状（体重减轻、厌食、吞咽困难和口干）、呼吸困难、谵妄以及一些生物学因素（白细胞增多、淋巴细胞减少和C反应蛋白），达到了B级。
预期寿命的预后评估对于从事肿瘤学和姑息治疗的临床医生而言是一项重要的临床任务。通过结合临床经验和文献证据，更准确的预后评估是可行的，并且可以实现。使用和传达预后信息应成为多学科姑息治疗方法的一部分。
