Department of Oncology and Palliative Medicine, Nordland Hospital Trust, 8092, Bodø, Norway.
Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Artic University of Norway, 9038, Tromsø, Norway.
Strahlenther Onkol. 2018 Jun;194(6):533-538. doi: 10.1007/s00066-018-1259-5. Epub 2018 Jan 17.
Widely used prognostic scores, e. g., for brain or bone metastases, are based on disease- and patient-related factors such as extent of metastases, age and performance status, which were available in the databases used to develop the scores. Few groups were able to include patient-reported symptoms. In our department, all patients were assessed with the Edmonton Symptom Assessment System (ESAS, a one-sheet questionnaire addressing 11 major symptoms and wellbeing on a numeric scale of 0-10) at the time of treatment planning since 2012. Therefore, we analyzed the prognostic impact of baseline ESAS symptom severity.
Retrospective review of 102 patients treated with palliative radiotherapy (PRT) between 2012 and 2015. All ESAS items were dichotomized (below/above median). Uni- and multivariate analyses were performed to identify prognostic factors for survival.
The most common tumor types were prostate, breast and non-small cell lung cancer, predominantly with distant metastases. Median survival was 6 months. Multivariate analysis resulted in six significant prognostic factors. These were ESAS pain while not moving (median 3), ESAS appetite (median 5), Eastern Cooperative Oncology Group (ECOG) performance status, pleural effusion/metastases, intravenous antibiotics at start or within 2 weeks before PRT and no systemic cancer treatment.
Stronger pain while not moving and reduced appetite (below/above median) predicted significantly shorter survival. Development of new prognostic scores should include patient-reported symptoms and other innovative parameters because they were more important than primary tumor type, age and other traditional baseline parameters.
广泛使用的预后评分，例如脑转移或骨转移的评分，基于疾病和患者相关因素，如转移程度、年龄和表现状态，这些因素在开发评分时的数据库中是可用的。很少有研究小组能够纳入患者报告的症状。在我们科室，自 2012 年以来，所有患者在治疗计划时都使用埃德蒙顿症状评估系统（ESAS，一份单页问卷，涉及 11 种主要症状和幸福感，采用 0-10 的数字量表）进行评估。因此，我们分析了基线 ESAS 症状严重程度的预后影响。
回顾性分析了 2012 年至 2015 年间接受姑息性放疗（PRT）的 102 例患者。所有 ESAS 项目均分为（低于/高于中位数）两类。进行单变量和多变量分析，以确定生存的预后因素。
最常见的肿瘤类型是前列腺癌、乳腺癌和非小细胞肺癌，主要为远处转移。中位生存期为 6 个月。多变量分析得出了 6 个显著的预后因素。这些因素是：活动时的 ESAS 疼痛（中位数 3）、ESAS 食欲（中位数 5）、东部肿瘤协作组（ECOG）表现状态、胸腔积液/转移、PRT 开始时或 2 周内静脉使用抗生素以及无系统癌症治疗。
活动时疼痛加剧和食欲减退（低于/高于中位数）预示着生存时间显著缩短。新的预后评分的制定应包括患者报告的症状和其他创新参数，因为它们比原发肿瘤类型、年龄和其他传统基线参数更为重要。
