比较临床预测生存和姑息预后指数对终末期头颈部鳞状细胞癌患者的准确性。
Comparison of the accuracy of clinical prediction of survival and palliative prognostic index for patients with head and neck squamous cell carcinoma in the end-of-life setting.
机构信息
Department of Otolaryngology, Faculty of Medicine, Kagawa University, Postal cord 761-0793, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan.
Department of head and neck oncology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan.
出版信息
Auris Nasus Larynx. 2022 Feb;49(1):133-140. doi: 10.1016/j.anl.2021.06.003. Epub 2021 Jul 3.
OBJECTIVE
In the end-of-life stage of head and neck squamous cell carcinoma (HNSCC), predicting survival is essential to determine treatment procedure and place of care. Several reports have compared actual survival (AS) and clinical prediction of survival (CPS), a subjective prognostic prediction by attending physicians. However, specific studies focusing on patients with HNSCC are limited. Likewise, a comparison of the accuracy of CPS and palliative prognostic index (PPI), a prognostic tool using subjective assessment, has not been sufficiently investigated. This study aimed to clarify the correlation between AS and CPS/PPI and compare the accuracy of CPS and PPI in end-stage HNSCC.
METHODS
This retrospective study included patients with HNSCC in the end-of-life setting. Patients were recruited from the National Hospital Organization Shikoku Cancer Center between April 2011 and March 2019. Data on basic demography and clinical parameters when patients decided to start end-of-life care at the head and neck oncology division were collected. We examined the correlation between AS and CPS using Spearman's correlation coefficients. The area under the receiver operating characteristic curve of CPS and PPI for 30-day survival prediction were compared for predictive accuracy.
RESULTS
Among 98 eligible patients, 59 patients were enrolled in this study and analyzed. Of the 59 patients, CPS and PPI were calculated for 30 patients, whereas, only the PPI was calculated for 29 patients. The median AS and CPS were 35 (IQR: 9-73) days and 30 (IQR: 7-83) days, respectively. CPS and PPI (30 cases) were moderately correlated (r = 0.72, p<0.01). AS and CPS/PPI (30 cases) were significantly correlated (p<0.01) and showed a strong correlation (r = 0.86 and 0.80, respectively). In the 30-day survival prediction, the AUROCs of CPS and PPI (30 cases) were 0.967 (95%CI: 0.919-1) and 0.884 (95%CI: 0.767-1), respectively. Both CPS and PPI (30 cases) showed high accuracy in predicting the 30-day prognosis, with no significant difference (p = 0.077). The AUROC of PPI (59 cases) was 0.840 (95%CI: 0.711-0.969).
CONCLUSIONS
AS and CPS/PPI showed significant correlations. The high accuracy of CPS may have been influenced by the fact that multiple head and neck cancer specialists at a comprehensive cancer center estimated CPS. Both CPS and PPI showed high prognostic accuracy in predicting 30-day survival. This suggests that PPI is useful in centers among physicians and healthcare workers unfamiliar with head and neck cancer.
目的
在头颈部鳞状细胞癌（HNSCC）的终末期，预测生存情况对于确定治疗方案和护理场所至关重要。已有多项研究比较了实际生存（AS）和临床预测生存（CPS），即主治医生的主观预后预测。然而，专门针对 HNSCC 患者的具体研究有限。同样，CPS 和姑息预后指数（PPI）的准确性比较，即使用主观评估的预后工具，也尚未得到充分研究。本研究旨在阐明 AS 与 CPS/PPI 的相关性，并比较 CPS 和 PPI 在 HNSCC 终末期的准确性。
方法
这是一项回顾性研究，纳入了处于生命终末期的 HNSCC 患者。患者于 2011 年 4 月至 2019 年 3 月在国立医院组织四国癌症中心招募。收集患者在头颈部肿瘤科决定开始终末期护理时的基本人口统计学和临床参数数据。我们使用 Spearman 相关系数检验 AS 与 CPS 之间的相关性。比较 CPS 和 PPI 对 30 天生存预测的受试者工作特征曲线下面积，以评估预测准确性。
结果
在 98 名符合条件的患者中，有 59 名患者入组并进行了分析。在这 59 名患者中，有 30 名患者计算了 CPS 和 PPI，而有 29 名患者仅计算了 PPI。中位 AS 和 CPS 分别为 35（IQR：9-73）天和 30（IQR：7-83）天。CPS 和 PPI（30 例）中度相关（r=0.72，p<0.01）。AS 和 CPS/PPI（30 例）显著相关（p<0.01），相关性较强（r=0.86 和 0.80）。在 30 天生存预测中，CPS 和 PPI（30 例）的 AUC 分别为 0.967（95%CI：0.919-1）和 0.884（95%CI：0.767-1）。CPS 和 PPI（30 例）均能高度准确地预测 30 天预后，差异无统计学意义（p=0.077）。PPI（59 例）的 AUC 为 0.840（95%CI：0.711-0.969）。
结论
AS 和 CPS/PPI 存在显著相关性。CPS 的高准确性可能受到综合癌症中心的多名头颈部癌症专家对 CPS 进行评估的影响。CPS 和 PPI 均能高度准确地预测 30 天生存。这表明 PPI 对于不熟悉头颈部癌症的医生和医疗保健工作者来说是有用的。
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