Stockler M R, Tattersall M H N, Boyer M J, Clarke S J, Beale P J, Simes R J
Department of Medical Oncology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050 Australia.
Br J Cancer. 2006 Jan 30;94(2):208-12. doi: 10.1038/sj.bjc.6602908.
People affected by cancer want information about their prognosis but clinicians have trouble estimating and talking about it. We sought to determine the nature and accuracy of medical oncologists' estimates of life expectancy in newly referred patients with incurable cancer. With reference to each patient, medical oncologists estimated how long they thought 90, 50, and 10% of similar patients would live. These proportions were chosen to reflect worst case, predicted, and best case scenarios suitable for discussions. After a median follow-up of 35 months, 86 of the 102 patients had died with an observed median survival of 12 months. Oncologists' estimates of each patient's worst case, predicted and best case scenarios were well-calibrated: 10% of patients lived for fewer months than estimated for the worst 10% of similar patients; 50% lived for at least as long as estimated for 50% of similar patients (predicted survival), and 17% lived for more months than estimated for the best 10% of similar patients. Oncologists' estimates of each patient's predicted survival were imprecise: 29% were within 0.67-1.33 times the patient's actual survival, 35% were too optimistic (>1.33 times the actual survival), and 39% were too pessimistic (<0.67 times the actual survival). The proportions of patients with actual survival times bounded by simple multiples of their predicted survival were as follows: 61% between half to double their predicted, 6% at least three to four times their predicted, and 4% no more than 1/6 of their predicted; similar to the proportions in an exponential distribution (about 50%, 10% and 10% respectively). Ranges based on simple multiples of the predicted survival time appropriately convey prognosis and its uncertainty in newly referred people with incurable cancer.
癌症患者希望了解自己的预后情况，但临床医生在评估和谈论预后时存在困难。我们试图确定肿瘤内科医生对新转诊的无法治愈癌症患者预期寿命估计的性质和准确性。针对每位患者，肿瘤内科医生估计他们认为90%、50%和10%的类似患者能存活多长时间。选择这些比例是为了反映适合讨论的最坏情况、预测情况和最佳情况。在中位随访35个月后，102名患者中有86人死亡，观察到的中位生存期为12个月。肿瘤内科医生对每位患者最坏情况、预测情况和最佳情况的估计校准良好：10%的患者存活时间短于对10%最坏情况类似患者的估计；50%的患者存活时间至少与对50%类似患者的估计一样长（预测生存期），17%的患者存活时间长于对10%最佳情况类似患者的估计。肿瘤内科医生对每位患者预测生存期的估计不准确：29%在患者实际生存期的0.67至1.33倍之间，35%过于乐观（>实际生存期的1.33倍），39%过于悲观（<实际生存期的0.67倍）。实际生存时间受预测生存期简单倍数限制的患者比例如下：61%在预测生存期的一半至两倍之间，6%至少为预测生存期的三至四倍，4%不超过预测生存期的1/6；与指数分布中的比例相似（分别约为50%、10%和10%）。基于预测生存时间简单倍数的范围能恰当传达新转诊的无法治愈癌症患者的预后及其不确定性。
