Nieder Carsten, Kämpe Thomas A
Department of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodø, Norway
Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Artic University of Norway, Tromsø, Norway.
Anticancer Res. 2018 Mar;38(3):1705-1709. doi: 10.21873/anticanres.12404.
BACKGROUND/AIM: Typically, prognostic scores predicting survival in patients with metastatic cancer are based on disease- and patient-related factors, such as extent of metastases, age and performance status. Patient-reported symptoms have been included less often. Our group has assessed all patients with the Edmonton Symptom Assessment System (ESAS, a one-sheet questionnaire addressing 11 major symptoms and wellbeing on a numeric scale of 0-10) before palliative radiotherapy (PRT) since 2012. Therefore, we were able to analyze the prognostic impact of baseline ESAS symptom severity.
We performed a retrospective review of 102 patients treated with PRT between 2012 and 2015. All ESAS items were analyzed by two different methods, dichotomized by median score and by score <4 vs. ≥4. Uni- and multivariable analyses were performed to identify prognostic factors for survival, and from these a 4-tiered score was developed.
The most common tumor types were prostate, breast and non-small cell lung cancer, predominantly with distant metastases. Despite differences between the two methods of ESAS data handling, the final multivariable models were strikingly similar. Therefore, the better reproducible cut-off was chosen, i.e. a score ≥4. Multivariable analyses resulted in 4 significant prognostic factors, which contributed equally to the 4-tiered survival score (performance status, more than one cancer diagnosis, progressive disease outside the PRT target volume(s), ESAS appetite). Estimated median survival for different point sums was 24.5 months (0), 8.4 months (1), 4.7 months (2) and 3.0 months (3), p=0.0001.
This score identified patients with different survival outcomes, including a good prognostic group with median survival of approximately 2 years. The results may be useful to inform PRT fractionation.
背景/目的：通常，预测转移性癌症患者生存率的预后评分是基于疾病和患者相关因素，如转移范围、年龄和体能状态。患者报告的症状较少被纳入其中。自2012年以来，我们团队在姑息性放疗（PRT）前使用埃德蒙顿症状评估系统（ESAS，一张涵盖11种主要症状及健康状况的问卷，采用0至10的数字评分）对所有患者进行了评估。因此，我们能够分析基线ESAS症状严重程度的预后影响。
我们对2012年至2015年间接受PRT治疗的102例患者进行了回顾性研究。所有ESAS项目通过两种不同方法进行分析，一种是按中位数评分进行二分法分析，另一种是按评分<4与≥4进行分析。进行单变量和多变量分析以确定生存的预后因素，并据此制定了一个4级评分。
最常见的肿瘤类型是前列腺癌、乳腺癌和非小细胞肺癌，主要伴有远处转移。尽管ESAS数据处理的两种方法存在差异，但最终的多变量模型惊人地相似。因此，选择了更好重现性的临界值，即评分≥4。多变量分析得出4个显著的预后因素，它们对4级生存评分的贡献相同（体能状态、不止一种癌症诊断、PRT靶区外的疾病进展、ESAS食欲评分）。不同分数总和的估计中位生存期分别为24.5个月（0分）、8.4个月（1分）、4.7个月（2分）和3.0个月（3分），p = 0.0001。
该评分识别出了具有不同生存结局的患者，包括一个中位生存期约为2年的良好预后组。这些结果可能有助于指导PRT的分割方案。
