Mercadante Sebastiano, Grassi Yasmine, Lo Cascio Alessio, Casuccio Alessandra
Main Regional Center of Pain Relief and Supportive/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146 Palermo, Italy.
Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy.
Cancers (Basel). 2025 May 19;17(10):1704. doi: 10.3390/cancers17101704.
Survival prediction in the advanced cancer care setting plays a vital role treatment planning and patients' arrangements. The aim of this study was to examine the association of the global Edmonton Symptom Assessment System (GESAS) and Karnofsky scale (KPS) with overall survival (OS) in patients with advanced cancers admitted to an acute palliative care unit (APCU). The second aim was to assess if GESAS changes after comprehensive palliative treatment could influence OS. This is a prospective planned sub-analysis of advanced cancer patients. A consecutive sample of 521 patients admitted to an APCU. Patients with available survival in follow-up phone calls, having complete ESAS, and discharged alive were selected. KPS and GESAS were measured at admission and after seven days of individual comprehensive palliative care. Two hundred forty-three of 521 screened patients were assessed according to inclusion criteria. The mean age was 67.1 years (SD 11.5), and 121 patients were male. The mean KPS was 43.5 (SD 9.3). The mean OS was 74.6 (SD 136.2) days. Significant changes in GESAS were observed after one week. Univariate linear regression analysis showed that KPS and GESAS at T0 and at T7 were correlated with OS ( < 0.0005; = 0.020; < 0.0005, respectively). At multivariate analysis, OS was correlated with KPS and GESAS at discharge (B = 3.349, 95% CI = 1.560-5.137; B = -2.430, 95% CI = -3.831--1.029). KPS and poor response to intensive treatment, maintaining high GESAS scores, can be considered predictive factors of shorter OS. Further studies should confirm whether a specialized intervention in other settings can improve OS.
晚期癌症护理环境中的生存预测在治疗规划和患者安排中起着至关重要的作用。本研究的目的是探讨全球埃德蒙顿症状评估系统（GESAS）和卡诺夫斯基量表（KPS）与入住急性姑息治疗病房（APCU）的晚期癌症患者总生存期（OS）之间的关联。第二个目的是评估综合姑息治疗后GESAS的变化是否会影响总生存期。这是一项针对晚期癌症患者的前瞻性计划亚分析。连续抽取了521名入住APCU的患者。选择在随访电话中有可用生存期、拥有完整的埃德蒙顿症状评估系统（ESAS）且存活出院的患者。在入院时和个体综合姑息治疗7天后测量KPS和GESAS。根据纳入标准对521名筛查患者中的243名进行了评估。平均年龄为67.1岁（标准差11.5），男性患者121名。平均KPS为43.5（标准差9.3）。平均总生存期为74.6天（标准差136.2）。一周后观察到GESAS有显著变化。单变量线性回归分析显示，T0和T7时的KPS和GESAS与总生存期相关（分别为P<0.0005；P = 0.020；P<0.0005）。在多变量分析中，总生存期与出院时的KPS和GESAS相关（B = 3.349，95%置信区间 = 1.560 - 5.137；B = -2.430，95%置信区间 = -3.831 - -1.029）。KPS以及对强化治疗反应不佳、GESAS评分维持在高位，可被视为总生存期较短的预测因素。进一步的研究应证实其他环境中的专门干预是否能改善总生存期。
