Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
J Pain Symptom Manage. 2010 Feb;39(2):283-90. doi: 10.1016/j.jpainsymman.2009.06.014.
Autonomic nervous system dysfunction (AD) is a common syndrome in patients with advanced cancer. It is associated with decreased survival in several patient populations, including diabetes mellitus, heart failure, and neurological diseases. Based on this evidence, we hypothesized that autonomic dysfunction is associated with decreased survival in patients with advanced cancer.
The objective of this preliminary study was to test the association between AD, as measured by the standardized Ewing test and heart rate variability (HRV) measures, and survival in this patient population.
We examined the relationship between survival and parameters of AD in subjects who participated in a prospective study of autonomic dysfunction and hypogonadism in male patients with advanced cancer. Eligibility criteria were defined based on the prospective study protocol. We collected demographic information, date of death (obtained from the online Social Security Death Index database), date of study entry, and Ewing and HRV scores. We defined survival as the interval between study entry and date of death. A survival analysis was used to test the association between survival (in days) and Ewing test (0-5) and measures of HRV, including time domain (standard deviation of normal to normal beat interval [SDNN]) and frequency domain (ultra low, very low, low, and high). Four patients were still alive at the time of this study and included in the survival analysis as being censored.
Forty-seven male patients were included in this study. Median age was 59 years (range: 20-79), and 30 out of 47 (63%) were Caucasians. AD, defined as Ewing score greater than 2, was present in 38 out of 47 (80%) of the patients. Median Ewing score was 3 (1-5), indicating moderate to severe AD. Spearman correlation for Ewing score and SDNN was 0.44 (P = 0.002). There was a significant association between abnormal Ewing score and survival (P < 0.0001) and abnormal SDNN HRV and survival (P = 0.056).
AD is associated with shorter survival in male patients with advanced cancer. Further longitudinal research in a large cohort is justified based on.
自主神经功能障碍（AD）是晚期癌症患者的常见综合征。它与包括糖尿病、心力衰竭和神经疾病在内的几种患者群体的生存率降低有关。基于这一证据，我们假设自主神经功能障碍与晚期癌症患者的生存率降低有关。
本初步研究的目的是测试通过标准化 Ewing 测试和心率变异性（HRV）测量来衡量的 AD 与该患者人群的生存率之间的关联。
我们检查了自主神经功能障碍和晚期癌症男性患者中性腺功能减退症的前瞻性研究中参与的受试者的 AD 与生存率之间的关系。入选标准是根据前瞻性研究方案确定的。我们收集了人口统计学信息、死亡日期（从在线社会保障死亡指数数据库中获得）、研究入组日期以及 Ewing 和 HRV 评分。我们将生存定义为从研究入组到死亡日期的时间间隔。生存分析用于测试生存（以天数计）与 Ewing 测试（0-5）和 HRV 测量值（包括时域[正常到正常心跳间隔的标准差（SDNN）]和频域[超低、极低、低和高]）之间的关联。在本研究时，有 4 名患者仍然存活，并作为删失纳入生存分析。
本研究纳入了 47 名男性患者。中位年龄为 59 岁（范围：20-79），47 名患者中有 30 名（63%）为白种人。47 名患者中有 38 名（80%）存在 AD，定义为 Ewing 评分大于 2。中位 Ewing 评分为 3（1-5），表明存在中重度 AD。Ewing 评分和 SDNN 的 Spearman 相关系数为 0.44（P = 0.002）。异常 Ewing 评分与生存率之间存在显著关联（P < 0.0001），异常 SDNN HRV 与生存率之间也存在显著关联（P = 0.056）。
AD 与晚期癌症男性患者的生存率降低有关。基于此，有理由在更大的队列中进行进一步的纵向研究。
