临床医生预测晚期癌症门诊患者生存情况的表现。
Performance of clinician prediction of survival in oncology outpatients with advanced cancer.
机构信息
Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Family Medicine, Chungnam National University Hospital, Daejeon, South Korea.
出版信息
PLoS One. 2022 Apr 21;17(4):e0267467. doi: 10.1371/journal.pone.0267467. eCollection 2022.
BACKGROUND
We aimed to investigate the performance of clinician prediction of survival (CPS) and the association between CPS and the prognostic confidence of clinicians in ambulatory medical oncology outpatients.
METHODS
Eight medical oncologists estimated the expected survival of their patients in a prospective cohort study. They were asked to provide a temporal type of CPS in weeks, together with their level of confidence for each prediction (0-100%). We analyzed the accuracy of CPS, the association between CPS and the prognostic confidence, and the characteristics of patients showing inaccurate CPS.
RESULTS
A total of 200 advanced cancer patients were enrolled and the median overall survival was 7.6 months. CPS was accurate in 67 (33.5%) patients, underestimated in 87 (43.5%), and overestimated in 46 (23.0%). The overall accuracy of CPS for 12-week, 24-week, 36-week, and 48-week survival was 83.0%, 72.0%, 75.5%, and 74.0%, respectively. The specificity was highest for 12-week survival (90.2%) and the sensitivity was highest for 48-week survival (96.1%). The sensitivity of 12-week CPS was 51.4% and the area under the receiver operating characteristic (AUROC) curve was 0.79 (95% confidence interval [CI] 0.71-0.87). The prognostic confidence of clinicians was not significantly associated with the accuracy of prediction (P = 0.359). Patients with overestimated survival had significantly poorer global health status and physical/role/emotional functioning in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Additionally, they showed significantly higher levels of fatigue, nausea/vomiting, pain, dyspnea, and loss of appetite.
CONCLUSION
The overall accuracy of CPS in predicting 12-week to 48-week survival was high in medical oncology outpatients. However the sensitivity of 12-week CPS was low and prognostic confidence was not associated with the accuracy of CPS. Patients with overestimated CPS showed poorer quality of life and higher symptom burden.
背景
本研究旨在调查临床医生预测生存率（CPS）的表现，并探讨 CPS 与门诊肿瘤内科医生预后信心之间的关系。
方法
8 名肿瘤内科医生在一项前瞻性队列研究中估计其患者的预期生存时间。他们被要求以周为单位提供 CPS 的时间类型，并对每个预测结果的置信度（0-100%）进行评估。我们分析了 CPS 的准确性、CPS 与预后信心之间的关系，以及预测不准确的患者特征。
结果
共纳入 200 例晚期癌症患者，中位总生存期为 7.6 个月。CPS 在 67 例（33.5%）患者中准确，87 例（43.5%）患者中低估，46 例（23.0%）患者中高估。12 周、24 周、36 周和 48 周生存率的 CPS 总体准确性分别为 83.0%、72.0%、75.5%和 74.0%。12 周生存率的特异性最高（90.2%），48 周生存率的敏感性最高（96.1%）。12 周 CPS 的敏感性为 51.4%，受试者工作特征（ROC）曲线下面积（AUC）为 0.79（95%置信区间 [CI] 0.71-0.87）。临床医生的预后信心与预测准确性无显著相关性（P = 0.359）。与预测生存时间被低估的患者相比，预测生存时间被高估的患者在欧洲癌症研究与治疗组织生活质量问卷核心 30 项（EORTC QLQ-C30）中的总体健康状况和身体/角色/情感功能方面显著较差。此外，他们表现出显著更高水平的疲劳、恶心/呕吐、疼痛、呼吸困难和食欲减退。
结论
在肿瘤内科门诊患者中，CPS 预测 12 周到 48 周生存的总体准确性较高。然而，12 周 CPS 的敏感性较低，且预后信心与 CPS 的准确性无关。预测生存时间被高估的患者生活质量较差，症状负担较高。
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