现实世界中晚期癌症患者的生存预测：姑息预后评分、谵妄-姑息预后评分、姑息预后指数与姑息治疗研究预测模型中改良预后的比较
Survival prediction for advanced cancer patients in the real world: A comparison of the Palliative Prognostic Score, Delirium-Palliative Prognostic Score, Palliative Prognostic Index and modified Prognosis in Palliative Care Study predictor model.
作者信息
Baba Mika, Maeda Isseki, Morita Tatsuya, Inoue Satoshi, Ikenaga Masayuki, Matsumoto Yoshihisa, Sekine Ryuichi, Yamaguchi Takashi, Hirohashi Takeshi, Tajima Tsukasa, Tatara Ryohei, Watanabe Hiroaki, Otani Hiroyuki, Takigawa Chizuko, Matsuda Yoshinobu, Nagaoka Hiroka, Mori Masanori, Tei Yo, Hiramoto Shuji, Suga Akihiko, Kinoshita Hiroya
机构信息
Palliative Care Division, Saito Yukoukai Hospital, 7-2-18 Saito asagi, Ibaraki, Osaka 567-0085, Japan.
Department of Palliative Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
出版信息
Eur J Cancer. 2015 Aug;51(12):1618-29. doi: 10.1016/j.ejca.2015.04.025. Epub 2015 Jun 11.
PURPOSE
The aim of this study was to investigate the feasibility and accuracy of the Palliative Prognostic Score (PaP score), Delirium-Palliative Prognostic Score (D-PaP score), Palliative Prognostic Index (PPI) and modified Prognosis in Palliative Care Study predictor model (PiPS model).
PATIENTS AND METHODS
This multicentre prospective cohort study involved 58 palliative care services, including 19 hospital palliative care teams, 16 palliative care units and 23 home palliative care services, in Japan from September 2012 to April 2014. Analyses were performed involving four patient groups: those treated by palliative care teams, those in palliative care units, those at home and those receiving chemotherapy.
RESULTS
We recruited 2426 participants, and 2361 patients were finally analysed. Risk groups based on these instruments successfully identified patients with different survival profiles in all groups. The feasibility of PPI and modified PiPS-A was more than 90% in all groups, followed by PaP and D-PaP scores; modified PiPS-B had the lowest feasibility. The accuracy of prognostic scores was ⩾69% in all groups and the difference was within 13%, while c-statistics were significantly lower with the PPI than PaP and D-PaP scores.
CONCLUSION
The PaP score, D-PaP score, PPI and modified PiPS model provided distinct survival groups for patients in the three palliative care settings and those receiving chemotherapy. The PPI seems to be suitable for routine clinical use for situations where rough estimates of prognosis are sufficient and/or patients do not want invasive procedure. If clinicians can address more items, the modified PiPS-A would be a non-invasive alternative. In cases where blood samples are available or those requiring more accurate prediction, the PaP and D-PaP scores and modified PiPS-B would be more appropriate.
目的
本研究旨在探讨姑息预后评分（PaP评分）、谵妄-姑息预后评分（D-PaP评分）、姑息预后指数（PPI）以及姑息治疗研究预测模型改良版（PiPS模型）的可行性和准确性。
患者与方法
这项多中心前瞻性队列研究纳入了日本58家姑息治疗机构，其中包括19家医院姑息治疗团队、16家姑息治疗病房以及23家居家姑息治疗服务机构，研究时间为2012年9月至2014年4月。分析涉及四组患者：接受姑息治疗团队治疗的患者、在姑息治疗病房的患者、居家患者以及接受化疗的患者。
结果
我们招募了2426名参与者，最终对2361例患者进行了分析。基于这些工具的风险组成功识别出了所有组中具有不同生存特征的患者。PPI和改良PiPS-A在所有组中的可行性均超过90%，其次是PaP和D-PaP评分；改良PiPS-B的可行性最低。所有组中预后评分的准确性均≥69%，差异在13%以内，而PPI的c统计量显著低于PaP和D-PaP评分。
结论
PaP评分、D-PaP评分、PPI和改良PiPS模型为三种姑息治疗环境下的患者以及接受化疗的患者提供了不同的生存组。PPI似乎适用于预后粗略估计足够和/或患者不希望进行侵入性操作的常规临床情况。如果临床医生能够处理更多项目，改良PiPS-A将是一种非侵入性的选择。在可获取血样或需要更准确预测的情况下，PaP和D-PaP评分以及改良PiPS-B将更为合适。
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