Barbot Anne-Claire, Mussault Pascale, Ingrand Pierre, Tourani Jean-Marc
Palliative Care Support Team, Clinical Research Unit, Department of Oncology, Poitiers University Hospital, Poitiers, France.
J Clin Oncol. 2008 May 20;26(15):2538-43. doi: 10.1200/JCO.2007.14.9518.
The aim of this study was to assess clinical, laboratory, and subjective (patient's preferences) prognostic factors in hospitalized patients with advanced solid tumors.
This prospective study surveyed 177 patients from two French hospitals who had not reached the stage of active dying but had an estimated survival of less than 6 months (median survival, 58 days).
Univariate analysis showed that 10 of the 13 clinical and laboratory factors reported in the literature affected survival at 2 months. Poor prognostic factors were number of metastatic sites, cerebral metastasis, low Karnofsky index, dyspnea at rest, anorexia, edema, confusion, low serum albumin, extremely high leukocyte counts, and high lactate dehydrogenase (LDH) levels. The patient's desire to continue curative treatment was also associated with survival. The multivariate analysis selected four independent criteria: Karnofsky index (in three classes: <or= 30%, 40% to 60%, or >or= 70%), number of metastatic sites (>or= two or < two), low serum albumin (in three classes: <or= 24, 24 to 33, and >or= 33 g/L), and LDH concentration (>or= 600 IU or < 600 IU). The combination of these four criteria assessed prognosis better than the Karnofsky index alone, producing three prognostic profiles: one with short survival (< 2 months: no patient survived to 4 months); one with an expectation of intermediate survival (25% were alive at 4 months), and a final group surviving for several months (80% were alive at 4 months).
The prognostic profiles defined by combinations of these four factors may be potentially useful but need further validation before their application in the daily practice.
本研究旨在评估晚期实体瘤住院患者的临床、实验室及主观（患者偏好）预后因素。
这项前瞻性研究对来自两家法国医院的177例患者进行了调查，这些患者尚未进入濒死阶段，但预计生存期少于6个月（中位生存期为58天）。
单因素分析显示，文献报道的13项临床和实验室因素中有10项影响2个月时的生存率。不良预后因素包括转移部位数量、脑转移、卡氏评分低、静息时呼吸困难、厌食、水肿、意识模糊、血清白蛋白水平低、白细胞计数极高以及乳酸脱氢酶（LDH）水平高。患者继续进行根治性治疗的意愿也与生存率相关。多因素分析选择了四个独立标准：卡氏评分（分为三类：≤30%、40%至60%或≥70%）、转移部位数量（≥两个或＜两个）、血清白蛋白水平低（分为三类：≤24、24至33以及≥33 g/L）和LDH浓度（≥600 IU或＜600 IU）。这四个标准的组合比单独使用卡氏评分能更好地评估预后，产生了三种预后情况：一种生存期短（＜2个月：无患者存活至4个月）；一种预期生存期中等（25%在4个月时存活），最后一组存活数月（80%在4个月时存活）。
由这四个因素组合定义的预后情况可能具有潜在用途，但在日常实践中应用之前需要进一步验证。
