Simmons Claribel P L, McMillan Donald C, McWilliams Kerry, Sande Tonje A, Fearon Kenneth C, Tuck Sharon, Fallon Marie T, Laird Barry J
University of Edinburgh, Edinburgh, UK.
Department of Surgical Sciences, University of Glasgow, Glasgow, UK.
J Pain Symptom Manage. 2017 May;53(5):962-970.e10. doi: 10.1016/j.jpainsymman.2016.12.330. Epub 2017 Jan 4.
In 2005, the European Association for Palliative Care made recommendations for prognostic markers in advanced cancer. Since then, prognostic tools have been developed, evolved, and validated. The aim of this systematic review was to examine the progress in the development and validation of prognostic tools.
Medline, Embase Classic and Embase were searched. Eligible studies met the following criteria: patients with incurable cancer, >18 years, original studies, population n ≥100, and published after 2003. Descriptive and quantitative statistical analyses were performed.
Forty-nine studies were eligible, assessing seven prognostic tools across different care settings, primary cancer types, and statistically assessed survival prediction. The Palliative Performance Scale was the most studied (n = 21,082), comprising six parameters (six subjective), was externally validated, and predicted survival. The Palliative Prognostic Score composed of six parameters (four subjective and two objective), the Palliative Prognostic Index composed of nine parameters (nine subjective), and the Glasgow Prognostic Score composed of two parameters (two objective) and were all externally validated in more than 2000 patients with advanced cancer and predicted survival.
Various prognostic tools have been validated but vary in their complexity, subjectivity, and therefore clinical utility. The Glasgow Prognostic Score would seem the most favorable as it uses only two parameters (both objective) and has prognostic value complementary to the gold standard measure, which is performance status. Further studies comparing all proved prognostic markers in a single cohort of patients with advanced cancer are needed to determine the optimal prognostic tool.
2005年，欧洲姑息治疗协会针对晚期癌症的预后标志物提出了建议。自那时起，预后工具得到了开发、改进和验证。本系统评价的目的是考察预后工具在开发和验证方面的进展。
检索了Medline、Embase Classic和Embase数据库。符合条件的研究满足以下标准：患有无法治愈癌症的患者、年龄>18岁、原始研究、样本量n≥100且发表于2003年之后。进行了描述性和定量统计分析。
49项研究符合条件，评估了7种不同护理环境、原发性癌症类型以及经统计学评估的生存预测的预后工具。姑息治疗表现量表研究最多（n = 21,082），包含6个参数（均为主观参数），已得到外部验证并可预测生存。姑息预后评分由6个参数组成（4个主观参数和2个客观参数），姑息预后指数由9个参数组成（9个主观参数），格拉斯哥预后评分由2个参数组成（2个客观参数），这三种工具均在2000多名晚期癌症患者中得到外部验证并可预测生存。
多种预后工具已得到验证，但在复杂性、主观性以及临床实用性方面存在差异。格拉斯哥预后评分似乎最为理想，因为它仅使用2个参数（均为客观参数），并且具有与金标准指标（即体能状态）互补的预后价值。需要进一步开展研究，在单一队列的晚期癌症患者中比较所有已证实的预后标志物，以确定最佳的预后工具。
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