Gripp Stephan, Moeller Sibylle, Bölke Edwin, Schmitt Gerd, Matuschek Christiane, Asgari Sonja, Asgharzadeh Farzin, Roth Stephan, Budach Wilfried, Franz Matthias, Willers Reinhardt
Department of Radiation Oncology, University Hospital Düsseldorf at Heinrich-Heine-University, Düsseldorf, Germany.
J Clin Oncol. 2007 Aug 1;25(22):3313-20. doi: 10.1200/JCO.2006.10.5411.
To study how survival of palliative cancer patients relates to subjective prediction of survival, objective prognostic factors (PFs), and individual psychological coping.
Survival was estimated according to three categories (< 1 month, 1 to 6 months, and > 6 months) by two physicians (A and B) and the institutional tumor board (C) for 216 patients recently referred for palliative radiotherapy. After 6 months, the accuracy of these estimates was assessed. The prognostic relevance of clinical symptoms, performance status, laboratory tests, and self-reported emotional distress (Hospital Anxiety and Depression Scale) was investigated.
In 61%, 55%, and 63% of the patients, prognoses were correctly estimated by A, B, and C, respectively. kappa statistic showed fair agreement of the estimates, which proved to be overly optimistic. Accuracy of the three estimates did not improve with increasing professional experience. In particular, the survival of 96%, 71%, and 87% of patients who died in less than 1 month was overestimated by A, B, and C, respectively. On univariate analysis, 11 of 27 parameters significantly affected survival, namely performance status, primary cancer, fatigue, dyspnea, use of strong analgesics, brain metastases, leukocytosis, lactate dehydrogenase (LDH), depression, and anxiety. On multivariate analysis, colorectal and breast cancer had a favorable prognosis, whereas brain metastases, Karnofsky performance status less than 50%, strong analgesics, dyspnea, LDH, and leukocytosis were associated with a poor prognosis.
This study revealed that physicians' survival estimates were unreliable, especially in the case of patients near death. Self-reported emotional distress and objective PFs may improve the accuracy of survival estimates.
研究姑息治疗癌症患者的生存期与生存期主观预测、客观预后因素（PFs）及个体心理应对之间的关系。
由两名医生（A和B）以及机构肿瘤委员会（C）根据三类情况（<1个月、1至6个月和>6个月）对最近转诊接受姑息性放疗的216例患者的生存期进行评估。6个月后，评估这些评估的准确性。研究了临床症状、体能状态、实验室检查以及自我报告的情绪困扰（医院焦虑抑郁量表）的预后相关性。
分别有61%、55%和63%的患者的预后被A、B和C正确估计。kappa统计显示评估结果一致性尚可，但结果被证明过于乐观。随着专业经验的增加，这三种评估的准确性并未提高。特别是，分别有96%、71%和87%在1个月内死亡的患者的生存期被A、B和C高估。单因素分析显示，27个参数中的11个显著影响生存期，即体能状态、原发癌、疲劳、呼吸困难、强效镇痛药的使用、脑转移、白细胞增多、乳酸脱氢酶（LDH）、抑郁和焦虑。多因素分析显示，结直肠癌和乳腺癌预后较好，而脑转移、卡氏评分低于50%、强效镇痛药、呼吸困难、LDH和白细胞增多与预后不良相关。
本研究表明医生对生存期的估计不可靠，尤其是对濒死患者。自我报告的情绪困扰和客观预后因素可能提高生存期估计的准确性。
