Kao Chen-Yi, Hung Yu-Shin, Wang Hung-Ming, Chen Jen-Shi, Chin Tsu-Ling, Lu Ching-Yi, Chi Chuan-Chuan, Yeh Ya-Chi, Yang Jin-Mei, Yen Jung-Hsuan, Chou Wen-Chi
Division of Hematology-Oncology, Department of Internal Medicine, Taoyuan, Taiwan.
Department of Nursing, Chang Gung Memorial Hospital at Linkou and School of Medicine, Chang Gung University, Taoyuan, Taiwan.
J Pain Symptom Manage. 2014 Nov;48(5):804-14. doi: 10.1016/j.jpainsymman.2013.12.246. Epub 2014 Apr 5.
The Palliative Prognostic Index (PPI) is among the most popular scores used to predict life expectancy in terminally ill patients worldwide. PPI assessed on the first day of palliative care might be inappropriate because the contribution from subsequent changes in a patient's condition are not taken into account.
The aim of this study is to determine the utility of sequential PPI assessments as a better prognostic tool for patients with terminal cancer.
In total, 2392 terminally ill cancer patients with initial and one-week PPI assessments under the palliative care consultation service between January 2006 and December 2011 at a single medical center in Taiwan were selected. Patients were categorized into initial PPI, Week 1 PPI, score change (initial PPI - Week 1 PPI; Δscore), and combined initial PPI and Δscore subgroups for survival analysis.
Overall median survival was 32 days (range eight to 180 days), and 2183 patients (91.3%) died within 180 days of palliative care consultation service care. A significant difference in survival was observed among patient subgroups (P < 0.001). Subgroup survival analysis showed significant difference in patients with Δscores >0, 0, and <0 in each prognostic group categorized by initial PPI. The c-statistic for predicting life expectancy <30 days was significantly higher with the combined initial PPI and Δscore (c-statistic, 0.71; 95% CI, 0.694-0.731) than with the initial PPI (c-statistic, 0.63; 95% CI, 0.61-0.65), Week 1 PPI (c-statistic, 0.67; 95% CI, 0.652-0.690), or Δscore (c-statistic, 0.64; 95% CI, 0.62-0.66).
Combination of initial PPI and score change is more useful than initial PPI for identifying patients with poor outcomes in good prognostic groups and patients with better outcomes in poor prognostic groups.
姑息预后指数（PPI）是全球用于预测晚期患者预期寿命的最常用评分之一。在姑息治疗第一天评估的PPI可能并不合适，因为未考虑患者病情随后变化的影响。
本研究旨在确定连续PPI评估作为晚期癌症患者更好的预后工具的效用。
选取2006年1月至2011年12月在台湾一家医疗中心接受姑息治疗咨询服务的2392例晚期癌症患者，对其进行初始和一周后的PPI评估。将患者分为初始PPI组、第1周PPI组、评分变化组（初始PPI - 第1周PPI；Δ评分）以及初始PPI与Δ评分联合组，进行生存分析。
总体中位生存期为32天（范围8至180天），2183例患者（91.3%）在姑息治疗咨询服务后180天内死亡。各患者亚组的生存情况存在显著差异（P < 0.001）。亚组生存分析显示，在按初始PPI分类的每个预后组中，Δ评分>0、=0和<0的患者生存情况存在显著差异。预测预期寿命<30天的c统计量，初始PPI与Δ评分联合组（c统计量，0.71；95%CI，0.694 - 0.731）显著高于初始PPI组（c统计量，0.63；95%CI，0.61 - 0.65）、第1周PPI组（c统计量，0.67；95%CI，0.652 - 0.690）或Δ评分组（c统计量，0.64；95%CI，0.62 - 0.66）。
对于识别预后良好组中预后不良的患者以及预后不良组中预后较好的患者，初始PPI与评分变化的联合比初始PPI更有用。
