Tassinari Davide, Montanari Luigi, Maltoni Marco, Ballardini Michela, Piancastelli Alessandra, Musi Marco, Porzio Giampiero, Minotti Vincenzo, Caraceni Augusto, Poggi Barbara, Stella Anna, Aielli Federica, Scarpi Emanuela
Department of Oncology, City Hospital, Rimini, Italy.
Support Care Cancer. 2008 Apr;16(4):359-70. doi: 10.1007/s00520-007-0302-3. Epub 2007 Jul 13.
To evaluate the accuracy of the Palliative Prognostic Score (PaP score) in selecting metastatic gastrointestinal or nonsmall-cell lung cancer patients candidate to palliative chemotherapy.
The PaP score was calculated in 173 patients with advanced, pretreated gastrointestinal or nonsmall-cell lung cancer before starting a further line of chemotherapy with palliative aim. Symptom distress score was calculated using the Edmonton Symptom Assessment System (ESAS) before every course of chemotherapy. Univariate analysis of survival was performed using the logrank test; multivariate analysis was performed using the Cox regression model. Symptom distress scores were compared using multivariate analysis of variance test for repeated measures, and overall symptom distress score was compared using analysis of variance test for repeated measures.
Overall median survival was 26 weeks; in PaP score class A it was 32 weeks, and in class B 8 weeks (p < 0.0001). No patient was classified in class C. The two-class PaP score resulted in an independent prognostic factor (p = 0.022), as well as Karnofsky performance status (p = 0.002) and colorectal cancer (p = 0.017). A trend towards worsening of symptom distress was observed in the entire population and in class A. The high number of missed data did not permit an adequate analysis in class B.
The PaP score seems to discriminate patients who could benefit by palliative chemotherapy from those who could better benefit by supportive and palliative approach. However, the data are insufficient to validate the use of the PaP score in patients to be treated with palliative chemotherapy, and further trials should be planned to assess its ability to improve the quality of care in oncology and the appropriateness in the choice of palliative chemotherapy.
评估姑息预后评分（PaP评分）在筛选适合姑息化疗的转移性胃肠道或非小细胞肺癌患者中的准确性。
在173例晚期、经预处理的胃肠道或非小细胞肺癌患者开始以姑息为目的的进一步化疗方案前，计算其PaP评分。在每疗程化疗前，使用埃德蒙顿症状评估系统（ESAS）计算症状困扰评分。采用对数秩检验进行生存单因素分析；采用Cox回归模型进行多因素分析。使用重复测量方差分析对症状困扰评分进行比较，使用重复测量方差分析对总体症状困扰评分进行比较。
总体中位生存期为26周；在PaP评分A类中为32周，在B类中为8周（p<0.0001）。无患者被分类为C类。两类PaP评分以及卡诺夫斯基体能状态（p=0.002）和结直肠癌（p=0.017）均为独立预后因素。在整个人群和A类中观察到症状困扰有加重趋势。B类中大量缺失数据无法进行充分分析。
PaP评分似乎能够区分哪些患者可从姑息化疗中获益，哪些患者更适合采用支持性和姑息性治疗方法。然而，现有数据不足以验证PaP评分在接受姑息化疗患者中的应用效果，应计划进一步试验以评估其改善肿瘤护理质量的能力以及在选择姑息化疗方面的合理性。
