预后评分优于临床医生判断吗？使用三个模型的前瞻性研究。
Are Prognostic Scores Better Than Clinician Judgment? A Prospective Study Using Three Models.
机构信息
Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Department of Palliative Medicine (Y.H.), Takeda General Hospital, Aizuwakamatsu, Japan; Department of Palliative Medicine (Y.H., A.I.), Tohoku University School of Medicine, Sendai, Japan; Department of Family Medicine (S.Y.S.), Dongguk University Ilsan Hospital, Goyang-si, South Korea; Department of Medicine (S.Y.S.), Dongguk University Medical School, Seoul, South Korea; Department of Palliative Care (D.H.), Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Palliative and Supportive Care (T.M., M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Biostatistics (S.O.), JORTC Data Center, Tokyo, Japan; Department of Palliative Medicine (K.A.), National Cancer Center Hospital, Tokyo, Japan; Seirei Hospice (K.I.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Medicine (M.B.), Suita Tokushukai Hospital, Suita, Japan; Department of Internal Medicine (H.K.), Hatsukaichi Memorial Hospital, Hatsukaichi, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Care (I.M.), Senri Chuo Hospital, Toyonaka, Japan; Division of Clinical Medicine (J.H.), Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
出版信息
J Pain Symptom Manage. 2022 Oct;64(4):391-399. doi: 10.1016/j.jpainsymman.2022.06.008. Epub 2022 Jun 17.
CONTEXT
Several prognostic models such as the Palliative Performance Scale (PPS), Palliative Prognostic Index (PPI), Palliative Prognostic Score (PaP) have been developed to complement clinician's prediction of survival (CPS). However, few studies with large scales have been conducted to show which prognostic tool had better performance than CPS in patients with weeks of survival.
OBJECTIVES
We aimed to compare the prognostic performance of the PPS, PPI, PaP, and CPS in inpatients admitted to palliative care units (PCUs).
METHODS
This study was part of a multi-center prospective observational study involving patients admitted to PCUs in Japan. We computed their prognostic performance using the area under the receiver operating characteristics curve (AUROC) and calibration plots for seven, 14-, 30- and 60-day survival.
RESULTS
We included 1896 patients with a median overall survival of 19 days. The AUROC was 73% to 84% for 60-day and 30-day survival, 75% to 84% for 14-day survival, and 80% to 87% for seven-day survival. The calibration plot demonstrated satisfactory agreement between the observational and predictive probability for the four indices in all timeframes. Therefore, all four prognostic indices showed good performance. CPS and PaP consistently had significantly better performance than the PPS and PPI from one-week to two-month timeframes.
CONCLUSION
The PPS, PPI, PaP, and CPS had relatively good performance in patients admitted to PCUs with weeks of survival. CPS and PaP had significantly better performance than the PPS and PPI. CPS may be sufficient for experienced clinicians while PPS may help to improve prognostic confidence for inexperienced clinicians.
背景
已经开发了几种预后模型，如姑息治疗表现量表（PPS）、姑息预后指数（PPI）、姑息预后评分（PaP），以补充临床医生对生存的预测（CPS）。然而，很少有大规模的研究表明，在生存时间为数周的患者中，哪种预后工具比 CPS 的性能更好。
目的
我们旨在比较 PPS、PPI、PaP 和 CPS 在姑息治疗病房（PCU）入院患者中的预后性能。
方法
本研究是一项多中心前瞻性观察性研究的一部分，涉及日本 PCU 入院的患者。我们使用接收者操作特征曲线（AUROC）下面积和校准图计算了他们的预后性能，以预测 7、14、30 和 60 天的生存情况。
结果
我们纳入了 1896 例中位总生存期为 19 天的患者。60 天和 30 天生存的 AUROC 为 73%至 84%，14 天生存的 AUROC 为 75%至 84%，7 天生存的 AUROC 为 80%至 87%。校准图显示，在所有时间范围内，四个指标的观测概率和预测概率之间具有令人满意的一致性。因此，所有四个预后指标均表现出良好的性能。从一周到两个月的时间范围内，CPS 和 PaP 始终比 PPS 和 PPI 具有更好的性能。
结论
PPS、PPI、PaP 和 CPS 在有生存时间为数周的 PCU 入院患者中具有相对较好的性能。CPS 和 PaP 比 PPS 和 PPI 具有更好的性能。对于经验丰富的临床医生来说，CPS 可能已经足够，而 PPS 可能有助于提高经验不足的临床医生的预后信心。
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