Zylla Dylan, Steele Grant, Gupta Pankaj
Division of Hematology/Oncology/Transplantation, Department of Medicine, University of Minnesota, 3931 Louisiana Ave S, Minneapolis, MN, 55426, USA.
Park Nicollet Oncology Research and HealthPartners Institute, St. Louis Park, MN, USA.
Support Care Cancer. 2017 May;25(5):1687-1698. doi: 10.1007/s00520-017-3614-y. Epub 2017 Feb 11.
Pain commonly occurs in cancer patients, and has been associated with shorter survival. However, the importance of pain is less clear when analyzed with other known prognostic variables. This systematic review was performed to better understand how pain impacts overall survival (OS) in common cancers when key clinical variables are included in multivariate analysis.
A Medline search was completed to find studies examining the relationship between pain, clinical variables, and OS in patients with breast, colorectal, lung, or prostate cancer. Multivariate analysis included known prognostic variables including age, performance status, disease burden, and laboratory parameters.
Fifty studies met inclusion criteria. In patients with breast, colorectal, and lung cancer, pain was not a significant prognostic factor for OS on multivariate analysis in most studies. In contrast, several studies suggest that pain is an independent prognostic factor for OS in advanced prostate cancer, even when relevant clinical prognostic variables are included. However, analgesic use was often used as a surrogate for prostate cancer pain, making it difficult to determine whether pain or opioid exposure was more important in influencing survival.
Pain may be associated with shorter survival in patients with cancer, but the mechanism for this relationship is unknown. The available evidence is insufficient to definitively determine if pain independently influences survival in patients with breast, colorectal, or lung cancer. The majority of studies in prostate cancer show pain to be an independent prognostic factor for OS, and often also incorporate opioid analgesic use in multivariate analysis. Prospective studies are needed to better understand how opioid utilization and pain may affect cancer progression and survival in diverse malignancies.
疼痛在癌症患者中普遍存在，且与生存期缩短有关。然而，当与其他已知的预后变量一起分析时，疼痛的重要性尚不清楚。进行这项系统评价是为了更好地了解在多变量分析中纳入关键临床变量时，疼痛如何影响常见癌症患者的总生存期（OS）。
完成了一项Medline检索，以查找研究乳腺癌、结直肠癌、肺癌或前列腺癌患者疼痛、临床变量与总生存期之间关系的研究。多变量分析纳入了已知的预后变量，包括年龄、体能状态、疾病负担和实验室参数。
50项研究符合纳入标准。在乳腺癌、结直肠癌和肺癌患者中，大多数研究的多变量分析显示疼痛并非总生存期的显著预后因素。相比之下，几项研究表明，即使纳入了相关临床预后变量，疼痛仍是晚期前列腺癌总生存期的独立预后因素。然而，镇痛药物的使用常被用作前列腺癌疼痛的替代指标，因此难以确定疼痛或阿片类药物暴露在影响生存方面哪个更重要。
疼痛可能与癌症患者生存期缩短有关，但这种关系的机制尚不清楚。现有证据不足以明确确定疼痛是否独立影响乳腺癌、结直肠癌或肺癌患者的生存。大多数前列腺癌研究表明疼痛是总生存期的独立预后因素，且多变量分析中常纳入阿片类镇痛药物的使用情况。需要开展前瞻性研究，以更好地了解阿片类药物的使用和疼痛如何影响不同恶性肿瘤的进展和生存。
