Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
Brighton and Sussex Medical School, Brighton, UK.
Clin Oncol (R Coll Radiol). 2020 Sep;32(9):553-561. doi: 10.1016/j.clon.2020.06.016. Epub 2020 Jul 16.
Oncologists should recognise the need to move beyond the Eastern Cooperative Oncology Group Performance Status (ECOG PS) score. ECOG PS is a longstanding and ubiquitous feature of oncology. It was evolved 40 years ago as an adaption of the 70-year-old Karnofsky performance score. It is short, easily understood and part of the global language of oncology. The wide prevalence of the ECOG PS attests to its proven utility and worth to help triage patient treatment. The ECOG PS is problematic. It is a unidimensional functional score. It is mostly physician assessed, subjective and therefore open to bias. It fails to account for multimorbidity, frailty or cognition. Too often the PS is recorded only once in wilful ignorance of a patient's changing physical state. As modern oncology offers an ever-widening array of therapies that are 'personalised' to tumour genotype, modern oncologists must strive to better define patient phenotype. Using a wider range of scoring and assessment tools, oncologists can identify deficits that may be reversed or steps taken to mitigate detrimental effects of treatment. These tools can function well to identify those patients who would benefit from comprehensive assessment. This overview identifies the strengths of ECOG PS but highlights the weaknesses and where these are supported by other measures. A strong recommendation is made here to move to routine use of the Clinical Frailty Score to start to triage patients and most appropriately design treatments and rehabilitation interventions.
肿瘤学家应该认识到需要超越东部合作肿瘤学组表现状态（ECOG PS）评分。ECOG PS 是肿瘤学中一个长期存在且无处不在的特征。它是 40 年前从已有 70 年历史的卡氏功能状态评分演变而来的。它简短、易于理解，是肿瘤学全球通用语言的一部分。ECOG PS 的广泛流行证明了其在帮助患者治疗分类方面的实用价值和作用。ECOG PS 存在问题。它是一种单一维度的功能评分。它主要由医生评估，具有主观性，因此容易受到偏见的影响。它没有考虑到多病共存、虚弱或认知能力。太多时候，PS 只是在患者身体状况不断变化的情况下被故意记录一次。随着现代肿瘤学提供了越来越多针对肿瘤基因型的“个体化”治疗方法，现代肿瘤学家必须努力更好地定义患者的表型。使用更广泛的评分和评估工具，肿瘤学家可以识别出可能逆转的缺陷，或采取措施减轻治疗的不利影响。这些工具可以很好地识别出那些需要全面评估的患者。本综述确定了 ECOG PS 的优势，但强调了其弱点，以及其他措施在哪些方面支持了它。这里强烈建议常规使用临床虚弱评分来开始对患者进行分类，并最适当地设计治疗和康复干预措施。
