Department of Surgery, Grey's Hospital, South Africa and Department of Surgery, College of Health Sciences, School of Clinical Medicine, University of KwaZulu-Natal, South Africa.
Division of Medical Oncology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa and Noncommunicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, South Africa and Soweto Comprehensive Cancer Centre, Chris Hani Baragwanath Academic Hospital, South Africa.
S Afr J Surg. 2023 Mar;61(1):66-74.
Most patients who present to South African state hospitals with advanced stage oesophageal squamous cell cancer (OSCC) disease receive palliative treatment. This study aimed to assess the factors that influence survival in patients with OSCC who received palliative management and to develop a prognostic score to aid clinicians in decisionmaking.
Analysis of a prospectively collected database assessed factors influencing survival of patients diagnosed with OSCC receiving palliative treatment. Factors assessed included patient demographics, clinical and laboratory data and tumour factors. A multivariable logistic regression model was used to assess for significant factors associated with survival time and a prognostic score was developed and internally validated based on these factors.
There were 384 patients with a male-to-female ratio of 1.3:1. The median survival of the cohort was 3.7 months. Factors that influenced survival on multivariate analysis included area of residence (aOR 1.82, 95% CI 1.02-3.24), performance status (aOR 2.56, 95% CI 1.50-4.35), body mass index (aOR 1.87, 95% CI 1.14-3.06) and serum albumin (aOR 3.06, 95% CI 1.46-6.42). The final prognostic score contained three of the four independent variables based on the regression coefficient for each variable. After internal validation, the risk score maintained fair discrimination and good calibration.
The prognostic scoring system based on patient performance status, body mass index and serum albumin, if validated on an independent cohort, would allow more objective decisions on whether to stage or not prior to embarking on palliative treatment, streamlining care and improving quality of life.
大多数在南非国有医院就诊的晚期食管鳞状细胞癌（OSCC）患者接受姑息治疗。本研究旨在评估接受姑息治疗的 OSCC 患者生存的影响因素，并制定预后评分以帮助临床医生做出决策。
分析前瞻性收集的数据库，评估接受姑息治疗的 OSCC 患者生存的影响因素。评估的因素包括患者的人口统计学、临床和实验室数据以及肿瘤因素。使用多变量逻辑回归模型评估与生存时间相关的显著因素，并根据这些因素开发并内部验证预后评分。
共有 384 名男性与女性的比例为 1.3:1。队列的中位生存时间为 3.7 个月。多变量分析中影响生存的因素包括居住地区（aOR 1.82，95%CI 1.02-3.24）、体力状态（aOR 2.56，95%CI 1.50-4.35）、体重指数（aOR 1.87，95%CI 1.14-3.06）和血清白蛋白（aOR 3.06，95%CI 1.46-6.42）。最终的预后评分包含四个独立变量中的三个，基于每个变量的回归系数。经过内部验证，风险评分保持了良好的区分度和校准度。
基于患者体力状态、体重指数和血清白蛋白的预后评分系统，如果在独立队列中得到验证，将允许更客观地决定是否在进行姑息治疗之前进行分期，从而简化护理并提高生活质量。
