晚期癌症患者的预后因素：临床病理因素与炎症为基础的预后系统的发展比较。
Prognostic factors in patients with advanced cancer: a comparison of clinicopathological factors and the development of an inflammation-based prognostic system.
机构信息
Authors' Affiliations: European Palliative Care Research Centre; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology; Departments of Oncology and Anaesthesiology and Emergency Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim; Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Oslo, Norway; University of Edinburgh, Edinburgh; and University of Glasgow, Glasgow, United Kingdom.
出版信息
Clin Cancer Res. 2013 Oct 1;19(19):5456-64. doi: 10.1158/1078-0432.CCR-13-1066. Epub 2013 Aug 12.
PURPOSE
In advanced cancer, oncological treatment is influenced by performance status (PS); however, this has limitations. Biomarkers of systemic inflammation may have prognostic value in advanced cancer. The study compares key factors in prognosis (performance status, patient-reported outcomes; PRO) with an inflammation-based score (Glasgow Prognostic Score, mGPS). A new method of prognosis in advanced cancer (combining performance status and mGPS) is tested and then validated.
EXPERIMENTAL DESIGN
Two international biobanks of patients with advanced cancer were analyzed. Key prognostic factors [performance status, PROs (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C-30), and mGPS (using C-reactive protein and albumin concentrations)] were examined. The relationship between these and survival was examined using Kaplan-Meier and Cox regression methods, in a test sample before independent validation.
RESULTS
Data were available on 1,825 patients (test) and 631 patients (validation). Median survival ranged from 3.2 months (test) to 7.03 months (validation). On multivariate analysis, performance status (HR 1.62-2.77) and mGPS (HR 1.51-2.27) were independently associated with, and were the strongest predictors of survival (P < 0.01). Survival at 3 months varied from 82% (mGPS 0) to 39% (mGPS 2) and from 75% (performance status 0-1) to 14% (performance status 4). When used together, survival ranged from 88% (mGPS 0, PS 0-1) to 10% (mGPS 2, performance status 4), P < 0.001.
CONCLUSION
A systemic inflammation-based score, mGPS, and performance status predict survival in advanced cancer. The mGPS is similar to performance status in terms of prognostic power. Used together, performance status and mGPS act synergistically improving prognostic accuracy. This new method may be of considerable value in the management of patients with advanced cancer.
目的
在晚期癌症中，肿瘤治疗受到身体状况（PS）的影响；然而，这存在局限性。全身炎症的生物标志物可能对晚期癌症具有预后价值。本研究比较了预后的关键因素（身体状况、患者报告的结果；PRO）与基于炎症的评分（格拉斯哥预后评分，mGPS）。测试并验证了一种新的晚期癌症预后方法（结合身体状况和 mGPS）。
实验设计
分析了两个国际晚期癌症生物库的患者数据。检查了关键预后因素[身体状况、PROs（欧洲癌症研究与治疗组织生活质量问卷 C-30）和 mGPS（使用 C 反应蛋白和白蛋白浓度）]。在测试样本中，使用 Kaplan-Meier 和 Cox 回归方法检查这些因素与生存的关系，然后在独立验证中进行验证。
结果
在测试中，有 1825 名患者和验证中有 631 名患者的数据可用。中位生存时间范围为 3.2 个月（测试）至 7.03 个月（验证）。多变量分析显示，身体状况（HR 1.62-2.77）和 mGPS（HR 1.51-2.27）与生存相关，是生存的最强预测因素（P < 0.01）。3 个月时的生存率从 mGPS 0 时的 82%到 mGPS 2 时的 39%不等，从身体状况 0-1 时的 75%到身体状况 4 时的 14%不等。当一起使用时，生存率从 mGPS 0、PS 0-1 时的 88%到 mGPS 2、PS 4 时的 10%不等，P < 0.001。
结论
全身性炎症评分 mGPS 和身体状况预测晚期癌症的生存。mGPS 在预后能力方面与身体状况相似。一起使用时，身体状况和 mGPS 协同作用，提高了预后准确性。这种新方法可能在晚期癌症患者的管理中具有重要价值。
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