Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases, Rome, Italy.
Eur J Haematol. 2012 Nov;89(5):410-6. doi: 10.1111/ejh.12004. Epub 2012 Sep 20.
To investigate whether patient-reported symptoms provide independent prognostic information for survival in patients with hematological malignancies.
Overall 119 patients with various diagnoses were recruited in an observational study and symptoms were assessed with the M.D. Anderson Symptom Inventory (MDASI). Key potential socio-demographic, biomedical, and physician-reported prognostic candidates were also considered. The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. Additional sensitivity analysis, based on 500 bootstrap-generated simulation datasets, was also performed to confirm the results obtained with the Cox regression model.
The median survival of the entire cohort was 4.8 months (range 0-28 months). The MDASI was completed at baseline by 91% of patients. The final multivariate model retained two parameters as independent prognostic factors for survival: clinical prognostic group and patient's self-reported severity of drowsiness. The following hazard ratios (HR) were found for curable vs. terminal: 0.055 (95% CI, 0.022-0.136; P < 0.001) and 0.193 (95% CI, 0.103-0.362: P < 0.001) for advanced vs. terminal. Patient's self-reported severity of drowsiness independently predicted survival with a HR of 1.801 (95% CI, 1.044-3.107; P = 0.033). Additional sensitivity analysis confirmed the independent prognostic value of variables identified in this study.
The results suggest that patients' self-reporting of symptoms provides independent prognostic information for survival in patients with hematologic malignancies. These findings underscore the value of collecting patient-reported symptom data in routine clinical practice.
研究患者报告的症状是否为血液恶性肿瘤患者生存的独立预后因素。
在一项观察性研究中，共招募了 119 名患有各种诊断的患者，并使用 MD 安德森症状量表（MDASI）评估症状。还考虑了关键的潜在社会人口统计学、生物医学和医生报告的预后候选因素。使用 Cox 比例风险回归模型对生存进行单变量和多变量分析。还基于 500 个 bootstrap 生成的模拟数据集进行了额外的敏感性分析，以确认 Cox 回归模型得出的结果。
整个队列的中位生存时间为 4.8 个月（范围 0-28 个月）。91%的患者在基线时完成了 MDASI。最终的多变量模型保留了两个参数作为生存的独立预后因素：临床预后组和患者自我报告的嗜睡严重程度。发现可治愈与终末期的以下风险比（HR）分别为：0.055（95%CI，0.022-0.136；P<0.001）和 0.193（95%CI，0.103-0.362：P<0.001）；晚期与终末期。患者自我报告的嗜睡严重程度独立预测生存，HR 为 1.801（95%CI，1.044-3.107；P=0.033）。额外的敏感性分析证实了本研究中确定的变量的独立预后价值。
结果表明，患者对症状的自我报告为血液恶性肿瘤患者的生存提供了独立的预后信息。这些发现强调了在常规临床实践中收集患者报告的症状数据的价值。
