Kajiyama Hiroaki, Utsumi Fumi, Higashi Makiko, Sakata Jun, Sekiya Ryuichiro, Mizuno Mika, Umezu Tomokazu, Suzuki Shiro, Yamamoto Eiko, Mitsui Hiroko, Niimi Kaoru, Shibata Kiyosumi, Kikkawa Fumitaka
1 Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine , Nagoya, Japan .
J Palliat Med. 2014 Mar;17(3):325-30. doi: 10.1089/jpm.2013.0366.
It remains unknown whether the end-of-life (EOL) environment influences survival after anticancer treatment, particularly for gynecologic malignancy.
The study's objective was to clarify whether the survival time varied depending on where patients spend the EOL.
This retrospective study included patients who received initial oncologic treatment but died due to cancer recurrence and/or progression. The subjects were a cohort of 181 gynecologic malignant tumor cases in a single institution from 2002 to 2008. Measurement was of postcancer treatment survival (PCS), defined as the time interval between the last date of anticancer treatment after recurrence/progression and death from the disease, analyzed on stratification by type of supportive care or where patients spent the EOL.
The median survival time was 26.1 (1.0-306.4) months. The distribution of the carcinoma type was as follows: 28.7% of patients with cervical (N=52), 27.6% with endometrial (N=50), and 43.1% with ovarian (N=79) cancer. The median PCS was 13.3 weeks. Patients in the hospice/home care group showed a significantly more favorable PCS than those in the hospital group (log rank: P=0.029). On multivariate analysis, the age (<60 versus ≥60) and site of supportive care (hospital versus hospice/home care) retained their significance as independent prognostic factors of poor PCS (age: HR=0.679, 95% CI, 0.496-0.928, P=0.0151; site of supportive care: HR=0.704, 95% CI, 0.511-0.970, P=0.0319).
Our current data could be hypothesis generating; it is possible that the EOL environment is a crucial prognostic factor for survival after anticancer treatment.
临终（EOL）环境是否会影响抗癌治疗后的生存情况，尤其是对于妇科恶性肿瘤而言，目前尚不清楚。
本研究的目的是明确生存时间是否会因患者临终时所处地点的不同而有所变化。
这项回顾性研究纳入了接受初始肿瘤治疗但因癌症复发和/或进展而死亡的患者。研究对象为2002年至2008年期间来自单一机构的181例妇科恶性肿瘤病例。测量指标为癌症治疗后生存期（PCS），定义为复发/进展后最后一次抗癌治疗日期与疾病死亡日期之间的时间间隔，并根据支持治疗类型或患者临终时所处地点进行分层分析。
中位生存时间为26.1（1.0 - 306.4）个月。癌症类型分布如下：宫颈癌患者占28.7%（N = 52），子宫内膜癌患者占27.6%（N = 50），卵巢癌患者占43.1%（N = 79）。中位PCS为13.3周。临终关怀/家庭护理组患者的PCS明显优于医院组患者（对数秩检验：P = 0.029）。多因素分析显示，年龄（<60岁与≥60岁）和支持治疗地点（医院与临终关怀/家庭护理）作为PCS不佳的独立预后因素仍具有显著性（年龄：HR = 0.679，95%CI，0.496 - 0.928，P = 0.0151；支持治疗地点：HR = 0.704，95%CI，0.511 - 0.970，P = 0.0319）。
我们目前的数据可能会引发假设；临终环境有可能是抗癌治疗后生存的关键预后因素。
