Center for Health Services Research, Henry Ford Health System, Detroit, Michigan, USA. R01 CA 114204-03, USA.
Cancer. 2011 Mar 1;117(5):1038-48. doi: 10.1002/cncr.25677. Epub 2010 Oct 18.
Performance status (PS) is a good prognostic factor in lung cancer and is used to assess chemotherapy appropriateness. Researchers studying chemotherapy use are often hindered by the unavailability of PS in automated data sources. To the authors' knowledge, no attempts have been made to estimate PS using claims-based measures. The current study explored the ability to estimate PS using routinely available measures.
A cohort of insured patients aged ≥50 years who were diagnosed with American Joint Committee on Cancer stage II through IV lung cancer between 2000 and 2007 was identified via a tumor registry (n = 552). PS was abstracted from medical records. Automated medical and pharmaceutical claims from the year preceding diagnosis were linked to tumor registry data. A logistic regression model was fit to estimate good versus poor PS in a random half of the sample. C statistics, sensitivity, specificity, and R2 were used to compare the predictive ability of models that included demographic factors, comorbidity measures, and claims-based utilization variables. Model fit was evaluated in the other half of the sample.
PS was available in 80% of medical records. The multivariable regression model predicted good PS with high sensitivity (0.88 or 0.94 depending on how good PS was defined), but moderate specificity (0.45 or 0.32) with a 0.50 prediction cutoff, and good sensitivity (0.64 or 0.83) and specificity (0.69 or 0.55) when the cutoff was 0.70. The goodness-of-fit c statistic was 0.76 or 0.78.
PS can be estimated, with some accuracy, using claims-based measures. Emphasis should be placed on documenting PS in medical records and tumor registries.
体能状态（PS）是肺癌的一个良好预后因素，用于评估化疗的适宜性。研究化疗使用情况的研究人员经常受到自动化数据来源中 PS 不可用的阻碍。据作者所知，尚未尝试使用基于索赔的指标来估计 PS。本研究探讨了使用常规可用指标来估计 PS 的能力。
通过肿瘤登记处确定了一组年龄≥50 岁的参保患者，他们在 2000 年至 2007 年间被诊断患有美国癌症联合委员会分期 II 至 IV 期肺癌（n=552）。PS 从病历中提取。诊断前一年的自动医疗和药品索赔与肿瘤登记数据相关联。在随机一半样本中拟合逻辑回归模型来估计良好与不良 PS。C 统计量、敏感性、特异性和 R2 用于比较包括人口统计学因素、合并症测量和基于索赔的利用变量的模型的预测能力。在另一半样本中评估模型拟合度。
80%的病历中都有 PS。多变量回归模型以高敏感性（根据 PS 定义的好坏，分别为 0.88 或 0.94）预测良好 PS，但特异性中等（0.45 或 0.32），截断值为 0.50，当截断值为 0.70 时，敏感性良好（0.64 或 0.83）和特异性（0.69 或 0.55）。拟合优度 c 统计量为 0.76 或 0.78。
PS 可以使用基于索赔的指标来准确估计。应强调在病历和肿瘤登记处记录 PS。
