Allard P, Dionne A, Potvin D
Groupe de Recherche en Epidémiologie, Université Laval.
J Palliat Care. 1995 Autumn;11(3):20-4.
To improve their ability to estimate the survival of terminally ill cancer patients, palliative care physicians require accurate information on prognostic factors. The objective of this study was to assess the extent to which variables such as patient characteristics and primary tumor site affect the length of survival of terminally ill cancer patients. The study population consisted of 1081 cancer patients admitted for terminal care to a 15-bed palliative care unit from 1985 to 1991. Univariate Kaplan-Meier survival analysis and multivariate Cox regression analyses were used to examine the relationship between patient characteristics at admission and survival time. The factor most strongly associated with shorter survival was poor performance status; this strong relationship was not altered by taking into account sex and primary cancer site in the multivariate analysis. For patients who were bedridden at admission, the death rate was 5.5 times higher (95% confidence interval (Cl) 3.4-9.0) than that for ambulatory patients during the first four days of stay, and it was 2.8 times higher (95% Cl 2.0-3.9) subsequently (up to 19 days). The other prognostic factors significantly but slightly associated with poorer survival in the univariate analysis were primary lung cancer, male sex, and living with a spouse. These findings indicate that performance status is the main prognostic factor for accurately estimating the survival time of terminally ill cancer patients.
为提高对晚期癌症患者生存情况的预估能力，姑息治疗医生需要有关预后因素的准确信息。本研究的目的是评估患者特征和原发肿瘤部位等变量对晚期癌症患者生存时长的影响程度。研究人群包括1985年至1991年入住一家拥有15张床位的姑息治疗病房接受终末期护理的1081例癌症患者。采用单因素Kaplan-Meier生存分析和多因素Cox回归分析来检验入院时患者特征与生存时间之间的关系。与较短生存期最密切相关的因素是身体状况差；在多因素分析中，考虑性别和原发癌部位后，这种密切关系并未改变。对于入院时卧床的患者，在住院的头四天内，死亡率比能走动的患者高5.5倍（95%置信区间（Cl）3.4 - 9.0），随后（直至19天）则高2.8倍（95% Cl 2.0 - 3.9）。在单因素分析中，与较差生存情况显著但略微相关的其他预后因素是原发性肺癌、男性以及与配偶同住。这些发现表明，身体状况是准确预估晚期癌症患者生存时间的主要预后因素。
