Kao Johnny, Gold Kenneth D, Zarrili Gina, Copel Emily, Silverman Andrew J, Ramsaran Shanta S, Yens David, Ryu Samuel
Good Samaritan Hospital Medical Center, Department of Radiation Oncology, West Islip, New York, United States of America.
Good Samaritan Hospital Medical Center, Division of Hematology and Medical Oncology, West Islip, New York, United States of America.
PLoS One. 2015 Apr 20;10(4):e0124329. doi: 10.1371/journal.pone.0124329. eCollection 2015.
There is an urgent need for a robust, clinically useful predictive model for survival in a heterogeneous group of patients with metastatic cancer referred to radiation oncology.
From May 2012 to August 2013, 143 consecutive patients with stage IV cancer were prospectively evaluated by a single radiation oncologist. We retrospectively analyzed the effect of 29 patient, laboratory and tumor-related prognostic factors on overall survival using univariate analysis. Variables that were statistically significant on univariate analysis were entered into a multivariable Cox regression to identify independent predictors of overall survival.
The median overall survival was 5.5 months. Four prognostic factors significantly predicted survival on multivariable analysis including ECOG performance status (0-1 vs. 2 vs. 3-4), number of active tumors (1 to 5 vs. ≥ 6), albumin levels (≥ 3.4 vs. 2.4 to 3.3 vs. < 2.4 and primary tumor site (Breast, Kidney or Prostate vs. Other). Risk group stratification was performed by assigning points for adverse prognostic factors resulting in very low, low, intermediate and high risk groups. The median survival was > 31.4 months for very low risk patients compared to 14.5 months for low risk, 4.1 months for intermediate risk and 1.2 months for high risk (p < 0.001).
These data suggest that a model that considers performance status, extent of disease, primary tumor site and serum albumin represents a simple model to accurately predict survival for patients with stage IV cancer who are potential candidates for radiation therapy.
对于转诊至放射肿瘤学的异质性转移性癌症患者群体，迫切需要一种强大且具有临床实用性的生存预测模型。
从2012年5月至2013年8月，由一名放射肿瘤学家对143例连续的IV期癌症患者进行前瞻性评估。我们使用单变量分析回顾性分析了29个患者、实验室及肿瘤相关预后因素对总生存期的影响。单变量分析中有统计学意义的变量被纳入多变量Cox回归，以确定总生存期的独立预测因素。
中位总生存期为5.5个月。多变量分析显示，四个预后因素可显著预测生存期，包括东部肿瘤协作组（ECOG）体能状态（0 - 1级与2级与3 - 4级）、活跃肿瘤数量（1至5个与≥6个）、白蛋白水平（≥3.4与2.4至3.3与<2.4）以及原发肿瘤部位（乳腺癌、肾癌或前列腺癌与其他）。通过为不良预后因素赋值进行风险组分层，分为极低、低、中、高风险组。极低风险患者的中位生存期>31.4个月，而低风险患者为14.5个月，中风险患者为4.1个月，高风险患者为1.2个月（p<0.001）。
这些数据表明，一个考虑体能状态、疾病范围、原发肿瘤部位和血清白蛋白的模型是一种简单的模型，可准确预测IV期癌症且可能接受放射治疗患者的生存期。
