生存期预测工具在终末期癌症患者中的比较:一项多中心前瞻性队列研究-现代医学

生存期预测工具在终末期癌症患者中的比较:一项多中心前瞻性队列研究

单位：1. 东南大学医学院, 江苏南京 210009;
2. 东南大学附属中大医院老年医学科, 江苏南京 210009;
3. 江苏省肿瘤医院疼痛综合科, 江苏南京 210009;
4. 江苏省肿瘤医院重症监护室, 江苏南京 210009;
5. 南京市小行医院护理部, 江苏南京 210012

关键词：护理安宁疗护生存期预测量表

分类号：R47

出版年·卷·期（页码）：2025·53·第三期（341-347）

摘要：

目的：分析卡氏功能状态评分(KPS)、姑息行为功能工具(PPS)、姑息预后指数(PPI)和谵妄-姑息预后评分(D-PaP)在中国终末期癌症患者生存期预测中的适用性及预测效能，为丰富患者生存期预测工具种类，拓宽生存期预测工具应用范围，提高患者生存期预测效果和临床医护者预测的准确性提供依据。方法：采用前瞻性的队列研究设计，招募2020年9月至2023年10月在江苏省4家医疗机构的终末期癌症患者304例，采用受试者工作特征(ROC)曲线探索KPS、PPS、PPI及D-PaP对终末期癌症患者7 d以及30 d生存预测的可行性，并以Kaplan-Meier生存曲线讨论新截断值下4种生存期预测工具的预测差异。结果：最终纳入286例终末期肿瘤患者，中位生存期为8(3，15) d。其中，在患者30 d生存期预测中，KPS、PPS、PPI 及D-PaP 的ROC曲线下的面积分别为0.783(95%CI：0.687~0.878)、0.756(95%CI：0.658~0.855)、0.759(95%CI：0.655~0.862)及0.872(95%CI：0.784~0.959)。Delong检验结果表明，在患者30 d生存期预测中D-PaP与KPS、PPI、PPS间差异均有统计学意义(均P<0.05)，而KPS、PPI、PPS之间相互比较差异均无统计学意义(均P>0.05)。KPS、PPS、PPI 及D-PaP 的最佳截断值分别为25、35、3.75和8.25，灵敏度分别为62.2%、76.0%、67.9%和88.5%，特异度分别为83.3%、70.8%、75.0%及83.3%。结论： KPS、PPS、PPI及D-PaP均可用于预测中国终末期癌症患者的生存期预测，其中D-PaP预测工具对30 d患者生存期的预测表现最佳。

Objective: To analyze the applicability and predictive efficacy of Karnofsky Performance Scale(KPS), Palliative Performance Scale(PPS), Palliative Performance Index(PPI), and Delirium-Palliative Prognostic Score(D-PaP) in predicting the survival of terminal cancer patients in China. This study aims to provide a basis for enriching the types of survival period prediction tools, expanding the application scope of survival period prediction tools, improving the prediction effect of survival period and the accuracy of clinical medical staff's prediction. Methods: A prospective cohort study design was employed to recruit terminal cancer patients 304 cases from four medical institutions in Jiangsu Province, between September 2020 and October 2023. The receiver operating characteristic(ROC) curve was used to evaluate the feasibility of the KPS, PPS, PPI, and D-PaP in predicting 7-day and 30-day terminal cancer patients. Additionally, the Kaplan-Meier survival curve was applied to examine the predictive differences among the four survival prediction tools based on a new cutoff value. Results: A total of 286 terminal cancer patients were included, with a median survival time of 8(3,15) days. For the 30-day survival prediction, the areas under the ROC curves for KPS, PPS, PPI, and D-PaP were 0.783(95%CI 0.687-0.878), 0.756(95%CI 0.658-0.855), 0.759(95%CI 0.655-0.862), and 0.872(95%CI 0.784-0.959), respectively. The Delong test results showed that there was a significant difference between D-PaP and KPS, PPI, and PPS for 30-day survival prediction(all P<0.05), while there was no significant difference among KPS, PPI, and PPS(all P>0.05). The optimal cut-off values of KPS, PPS, PPI and D-PaP were 25, 35, 3.75 and 8.25, respectively, with corresponding sensitivities of 62.2%, 76.0%, 67.9%, and 88.5%, and specificities of 83.3%, 70.8%, 75.0%, and 83.3%. Conclusion: KPS, PPS, PPI, and D-PaP can all be used to predict the survival period of terminal cancer patients in China, with D-PaP demonstrating particular suitability for predicting 30-day survival outcomes.

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