Faculty of Science, School of Psychology, Quality of Life Office, The University of Sydney, Sydney, NSW, Australia.
Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), The University of Sydney, Sydney, NSW, 2006, Australia.
Qual Life Res. 2019 Nov;28(11):2871-2887. doi: 10.1007/s11136-019-02255-0. Epub 2019 Jul 30.
The prognostic value of patient-reported outcomes (PROs) has been determined in some cancers, but a focussed review in colorectal cancer (CRC) has not yet been conducted. We systematically reviewed PRO predictors of CRC patient survival.
We searched four electronic databases (from inception to May 2018), reference lists and professional organisations to identify studies reporting pre-treatment PRO predictors of overall survival (OS) or progression-free survival (PFS) in CRC identified through univariate or multivariate models. Two reviewers independently applied inclusion criteria and extracted data on study characteristics, median and 1-year survival rates, PROs assessed and model results.
In 25 of 27 studies (n = 12,544), at least one PRO was significantly associated with survival. Physical functioning, fatigue, pain and appetite loss predicted OS more often than other PROs in metastatic disease (19/27 studies). One study explored PRO predictors in early-stage CRC, finding emotional well-being and mood predicted OS. In mixed-stage samples (7/27 studies), physical functioning predicted OS more often than other PROs. Few studies modelled PFS, for which few PROs had predictive value.
Physical and psychological functioning, pain, fatigue and appetite loss had prognostic significance above and beyond clinical predictors in CRC. Routine monitoring of these PROs may allow earlier detection and amelioration of problems, which may improve quality of life and perhaps extend survival. More research is needed to determine prognostic value of PROs in early-stage CRC, and prognostic significance of changes in PRO scores.
患者报告结局（PROs）的预后价值已在某些癌症中得到确定，但尚未在结直肠癌（CRC）中进行专门的综述。我们系统地回顾了预测 CRC 患者生存的 PRO 预测因子。
我们在四个电子数据库（从成立到 2018 年 5 月）、参考文献列表和专业组织中进行了检索，以确定报告通过单变量或多变量模型预测 CRC 患者总生存（OS）或无进展生存（PFS）的治疗前 PRO 预测因子的研究。两名评审员独立应用纳入标准，并提取研究特征、中位和 1 年生存率、评估的 PRO 和模型结果的数据。
在 27 项研究中的 25 项研究中（n=12544），至少有一项 PRO 与生存显著相关。在转移性疾病中，身体功能、疲劳、疼痛和食欲丧失比其他 PRO 更能预测 OS（27 项研究中的 19 项）。一项研究探索了早期 CRC 中 PRO 预测因子，发现情绪健康和情绪预测 OS。在混合阶段的样本中（7/27 项研究），身体功能比其他 PRO 更能预测 OS。很少有研究对 PFS 进行建模，PRO 对 PFS 的预测价值也很少。
在 CRC 中，身体和心理功能、疼痛、疲劳和食欲丧失除了临床预测因子外，具有预后意义。常规监测这些 PRO 可能有助于更早地发现和改善问题，从而提高生活质量并可能延长生存时间。需要进一步研究以确定 PRO 在早期 CRC 中的预后价值，以及 PRO 评分变化的预后意义。
