Good Samaritan Hospital Medical Center, Department of Radiation Oncology, West Islip, NY, U.S.A.;
Good Samaritan Hospital Medical Center, Department of Radiation Oncology, West Islip, NY, U.S.A.
Anticancer Res. 2022 Mar;42(3):1397-1401. doi: 10.21873/anticanres.15609.
BACKGROUND/AIM: NEAT is a validated prognostic model that calculates survival estimates based on the number of active tumors, ECOG performance status, albumin, and primary tumor site. Since models are imperfect, we hypothesized that experienced clinicians could predict the survival of patients with metastatic cancer better than a validated prognostic model alone, thereby quantifying the previously unmeasured value of clinical judgment.
This prospective, single-institution cohort study conducted at a large community hospital recruited 73 patients with metastatic cancer referred to radiation oncology between October 2016 and December 2017. The consulting nurse and physician were prospectively surveyed on whether the patient would survive a longer or shorter duration than the calculated NEAT survival estimates. The accuracy of predictions between groups was assessed using the McNemar's chi-squared test.
The median survival for enrolled patients was 9.2 months. Nursing and physician predictions were similarly accurate (61.6% vs. 60.3%, p=0.85). The accuracy of confident clinical predictions was similar to less confident predictions (64.2% vs. 58.2%, p=0.46). Radiation dose intensity was informed by predicted survival, and median survival was significantly higher in patients receiving an EQD2≥40 (17 months vs. 2 months, p<0.001).
Experienced clinicians, both nurses and oncologists, have insight that modestly supplements the accuracy of a validated model to predict survival in patients with advanced cancer.
背景/目的：NEAT 是一种经过验证的预后模型，它根据活跃肿瘤的数量、ECOG 表现状态、白蛋白和原发肿瘤部位来计算生存估计。由于模型并不完美，我们假设经验丰富的临床医生可以比单独使用经过验证的预后模型更好地预测转移性癌症患者的生存情况，从而量化以前无法衡量的临床判断的价值。
这项前瞻性、单中心队列研究在一家大型社区医院进行，招募了 2016 年 10 月至 2017 年 12 月期间转诊至放射肿瘤科的 73 例转移性癌症患者。前瞻性调查了咨询护士和医生，询问患者的生存时间是否会长于或短于计算出的 NEAT 生存估计。使用 McNemar 的卡方检验评估组间预测的准确性。
入组患者的中位生存时间为 9.2 个月。护理和医生的预测同样准确（61.6% vs. 60.3%，p=0.85）。有信心的临床预测的准确性与不太有信心的预测相似（64.2% vs. 58.2%，p=0.46）。预测生存情况决定了辐射剂量强度，接受 EQD2≥40 的患者的中位生存时间明显更高（17 个月 vs. 2 个月，p<0.001）。
经验丰富的临床医生（包括护士和肿瘤学家）具有洞察力，可以适度补充经过验证的模型的准确性，以预测晚期癌症患者的生存情况。
