Gwilliam Bridget, Keeley Vaughan, Todd Chris, Gittins Matthew, Roberts Chris, Kelly Laura, Barclay Stephen, Stone Patrick C
Division of Population, Health Sciences and Education, St George's University of London, London SW17 0RE, UK.
BMJ Support Palliat Care. 2012 Mar;2(1):63-71. doi: 10.1136/bmjspcare.2012.d4920rep.
To develop a novel prognostic indicator for use in patients with advanced cancer that is significantly better than clinicians' estimates of survival.
Prospective multicentre observational cohort study.
18 palliative care services in the UK (including hospices, hospital support teams, and community teams).
1018 patients with locally advanced or metastatic cancer, no longer being treated for cancer, and recently referred to palliative care services.
Performance of a composite model to predict whether patients were likely to survive for "days" (0-13 days), "weeks" (14-55 days), or "months+" (>55 days), compared with actual survival and clinicians' predictions.
On multivariate analysis, 11 core variables (pulse rate, general health status, mental test score, performance status, presence of anorexia, presence of any site of metastatic disease, presence of liver metastases, C reactive protein, white blood count, platelet count, and urea) independently predicted both two week and two month survival. Four variables had prognostic significance only for two week survival (dyspnoea, dysphagia, bone metastases, and alanine transaminase), and eight variables had prognostic significance only for two month survival (primary breast cancer, male genital cancer, tiredness, loss of weight, lymphocyte count, neutrophil count, alkaline phosphatase, and albumin). Separate prognostic models were created for patients without (PiPS-A) or with (PiPS-B) blood results. The area under the curve for all models varied between 0.79 and 0.86. Absolute agreement between actual survival and PiPS predictions was 57.3% (after correction for over-optimism). The median survival across the PiPS-A categories was 5, 33, and 92 days and survival across PiPS-B categories was 7, 32, and 100.5 days. All models performed as well as, or better than, clinicians' estimates of survival.
In patients with advanced cancer no longer being treated, a combination of clinical and laboratory variables can reliably predict two week and two month survival.
开发一种用于晚期癌症患者的新型预后指标，该指标要显著优于临床医生对生存期的估计。
前瞻性多中心观察性队列研究。
英国的18家姑息治疗服务机构（包括临终关怀医院、医院支持团队和社区团队）。
1018例局部晚期或转移性癌症患者，不再接受癌症治疗，近期转诊至姑息治疗服务机构。
与实际生存期和临床医生的预测相比，一个综合模型预测患者是可能存活“数天”（0 - 13天）、“数周”（14 - 55天）还是“数月以上”（>55天）的表现。
多变量分析显示，11个核心变量（脉搏率、总体健康状况、心理测试得分、体能状态、厌食情况、任何部位转移疾病的存在、肝转移的存在、C反应蛋白、白细胞计数、血小板计数和尿素）可独立预测两周和两个月生存期。4个变量仅对两周生存期具有预后意义（呼吸困难、吞咽困难、骨转移和丙氨酸转氨酶），8个变量仅对两个月生存期具有预后意义（原发性乳腺癌、男性生殖系统癌症、疲倦、体重减轻、淋巴细胞计数、中性粒细胞计数、碱性磷酸酶和白蛋白）。为无血液检查结果（PiPS - A）和有血液检查结果（PiPS - B）的患者分别创建了预后模型。所有模型的曲线下面积在0.79至0.86之间。实际生存期与PiPS预测之间的绝对一致性为57.3%（校正过度乐观因素后）。PiPS - A分类中的中位生存期分别为5天、33天和92天，PiPS - B分类中的生存期分别为7天、32天和100.5天。所有模型的表现与临床医生对生存期的估计相同或更好。
在不再接受治疗的晚期癌症患者中，临床和实验室变量的组合能够可靠地预测两周和两个月生存期。
