Sutradhar Rinku, Barbera Lisa
1Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Palliat Med. 2014 Feb;28(2):184-90. doi: 10.1177/0269216313499059. Epub 2013 Aug 9.
The relationship between performance status and death among cancer patients has been of increasing interest over the past years. However, few studies have implemented statistical models that adequately capture the longitudinal nature of performance status assessments collected under intermittent observation.
The main research aims were to examine the association between performance status and death and to determine the probability of deterioration in performance status over time.
This was a population-based longitudinal study among adult outpatients diagnosed with cancer. Throughout their observation period, all patients were repeatedly assessed for performance status using an 11-point scale with a score of 100 being the best, 10 being the worst and 0 representing death. A Markov multistate model accounting for intermittent observation was implemented in which each score represented a distinct state in the model.
The cohort consisted of 27,739 patients with over 157,000 assessments. The rate of transition to death increases with a quadratic trend as performance status declines. The 1-month and 3-month probability of deterioration also increases with a quadratic trend as performance status declines. The relative rate of transition to death decreases as we compare lower scores (relative rate = 2.20 for comparing scores 90 vs 100 and relative rate = 1.23 for comparing scores 10 vs 20).
There is a significant relationship between performance status and rate of transition to death. The Markov multistate model provides a comprehensive understanding of the shape of this relationship, which facilitates the interpretation of performance status and provides strength in its use as a prognostic tool in a clinical setting.
在过去几年中，癌症患者的体能状态与死亡之间的关系越来越受到关注。然而，很少有研究采用能充分捕捉在间歇性观察下收集的体能状态评估的纵向性质的统计模型。
主要研究目的是检验体能状态与死亡之间的关联，并确定体能状态随时间恶化的概率。
这是一项针对成年癌症门诊患者的基于人群的纵向研究。在整个观察期内，所有患者均使用11分制反复评估体能状态，其中100分为最佳，10分为最差，0分代表死亡。实施了一个考虑间歇性观察的马尔可夫多状态模型，其中每个分数在模型中代表一个不同的状态。
该队列由27739名患者组成，评估超过157000次。随着体能状态下降，向死亡转变的比率呈二次趋势增加。随着体能状态下降，1个月和3个月恶化的概率也呈二次趋势增加。当我们比较较低分数时，向死亡转变的相对比率降低（比较90分与100分的相对比率=2.20，比较10分与20分的相对比率=1.23）。
体能状态与向死亡转变的比率之间存在显著关系。马尔可夫多状态模型提供了对这种关系形式的全面理解，这有助于对体能状态的解释，并增强了其在临床环境中作为预后工具的实用性。
