Shin Hyun-Sik, Lee Hye-Ree, Lee Duk-Chul, Shim Jae-Yong, Cho Kyung-Hee, Suh Sang-Yeon
Department of Family Medicine (H.-S.S, H.-R.L, D.-C.L, J.-Y.S.), Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Pain Symptom Manage. 2006 Jun;31(6):493-501. doi: 10.1016/j.jpainsymman.2005.11.014.
The aim of this prospective cohort study was to determine whether serum uric acid level is useful as a predictor of survival in terminally ill cancer patients. One hundred eighteen terminally ill cancer patients, including 63 (53.4%) males, were categorized into four groups by serum uric acid levels and followed up until death or to the end of the study. Cox's proportional hazard model was adopted to evaluate the joint effect of some clinicobiological variables on survival. From an initial model containing 51 variables, a final parsimonious model was obtained by means of a stepwise method. Repetitive dispersion analysis was performed for serum uric acid level in 39 subjects for 3 weeks until death. During the study period, 113 (95.76%) subjects expired, and the median survival time was 14 days. In univariate analysis, survival time of the fourth highest group (> or =7.2mg/dL) was significantly shorter than that of the others (hazard ratio (HR)=2.784, P<0.001). After adjustment for low performance status, moderate to severe pain, prolonged prothrombin time, hypocholesterolemia, and high lactate dehydrogenase (LDH) level, high serum uric acid level (> or =7.2mg/dL) was significantly and independently associated with short survival time (HR=2.637, P=0.001). Serum uric acid levels were also significantly increased between the first and the second week before death. These findings suggest that serum uric acid level can be useful in predicting life expectancy in terminally ill cancer patients.
这项前瞻性队列研究的目的是确定血清尿酸水平是否有助于预测晚期癌症患者的生存期。118例晚期癌症患者，包括63例（53.4%）男性，根据血清尿酸水平分为四组，并随访至死亡或研究结束。采用Cox比例风险模型评估一些临床生物学变量对生存的联合影响。从包含51个变量的初始模型中，通过逐步法获得最终的简约模型。对39名受试者的血清尿酸水平进行了为期3周的重复离散分析，直至死亡。在研究期间，113例（95.76%）受试者死亡，中位生存时间为14天。单因素分析中，尿酸水平第四高组（≥7.2mg/dL）的生存时间显著短于其他组（风险比（HR）=2.784，P<0.001）。在调整了低体能状态、中度至重度疼痛、凝血酶原时间延长、低胆固醇血症和高乳酸脱氢酶（LDH）水平后，高血清尿酸水平（≥7.2mg/dL）与短生存时间显著且独立相关（HR=2.637，P=0.001）。血清尿酸水平在死亡前第一周和第二周之间也显著升高。这些发现表明血清尿酸水平有助于预测晚期癌症患者的预期寿命。
