Radiation Oncology Princess Alexandra Hospital Raymond Terrace, Brisbane, Queensland, Australia.
QUT, Faculty of Health, School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
J Med Imaging Radiat Oncol. 2021 Oct;65(6):806-816. doi: 10.1111/1754-9485.13185. Epub 2021 May 10.
Survival prediction for palliative cancer patients by physicians is often optimistic. Patients with a very short life expectancy (<4 weeks) may not benefit from radiation therapy (RT), as the time to maximal symptom relief after treatment can take 4-6 weeks. We aimed to identify a prognostic tool (or tools) to predict survival of less than 4 weeks and less than 3 months in patients with advanced cancer to guide the choice of radiation dose and fractionation. We searched Embase, Medline (EBSCOhost) and CINAHL (EBSCOhost) clinical databases for literature published between January 2008 and June 2018. Seventeen studies met the inclusion criteria and were included in the review. Prediction accuracy at less than 4 weeks and less than 3 months were compared across the prognostic tools. Reporting of prediction accuracy among the different studies was not consistent: the Palliative Prognostic Score (PaP), Palliative Prognostic Index (PPI) and Number of Risk Factors (NRF) best-predicted survival duration of less than 4 weeks. The PPI, performance status with Palliative Prognostic Index (PS-PPI), NRF and Survival Prediction Score (SPS) may predict 3-month survival. We recommend PPI and PaP tools to assess the likelihood of a patient surviving less than 4 weeks. If predicted to survive longer and RT is justified, the NRF tool could be used to determine survival probability less than 3 months which can then help clinicians select dose and fractionation. Future research is needed to verify the reliability of survival prediction using these prognostic tools in a radiation oncology setting.
医生对姑息治疗癌症患者的生存预测往往过于乐观。预期生存时间极短（<4 周）的患者可能无法从放射治疗（RT）中获益，因为治疗后症状缓解的时间可能需要 4-6 周。我们旨在确定一种预后工具（或多种）来预测晚期癌症患者生存时间少于 4 周和少于 3 个月，以指导选择放射剂量和分割。我们在 Embase、Medline（EBSCOhost）和 CINAHL（EBSCOhost）临床数据库中搜索了 2008 年 1 月至 2018 年 6 月期间发表的文献。符合纳入标准的 17 项研究被纳入综述。比较了不同预后工具在预测小于 4 周和小于 3 个月的生存时间方面的准确性。不同研究对预测准确性的报告不一致：姑息预后评分（PaP）、姑息预后指数（PPI）和风险因素数量（NRF）对预测生存时间少于 4 周的预测效果最好。PPI、带姑息预后指数的体能状态（PS-PPI）、NRF 和生存预测评分（SPS）可能预测 3 个月的生存率。我们建议使用 PPI 和 PaP 工具来评估患者生存时间少于 4 周的可能性。如果预计生存时间较长且 RT 合理，则可以使用 NRF 工具来确定生存时间少于 3 个月的概率，然后帮助临床医生选择剂量和分割。需要进一步的研究来验证这些预后工具在放射肿瘤学环境中用于生存预测的可靠性。
