Prognostic factors for survival in patients with inoperable lung cancer.
Prognostic factors for survival in patients with inoperable lung cancer.
复制标题
DOI：
10.1093/jnci/65.1.25
复制
发表时间：
1980-07
期刊：
影响因子：
--
通讯作者：
K. Stanley
中科院分区：
文献类型：
--
作者：
K. Stanley
在对5000多名不能手术的肺癌患者进行评估时，考虑了77个预后因素；这些患者被列入退伍军人管理局肺组协议9-15(1968-78)。确定了50个影响生存的预后因素，并考虑了它们对患者生存的相对贡献。影响生存的三个最重要的预后因素是Karnofsky初始表现状态评分、疾病程度和前6个月的体重减轻。这些因素表示三个一般的预后因素：当前身体状况、当前疾病状况和先前的身体状况。最初的表现状态是主要的预后因素。使用卡诺夫斯基量表来描述患者的功能状态比使用概括性量表或将其一分为二地划分为可活动的和非可移动的更可取。目前使用二分法的做法导致了许多预后信息的丢失。当单独考虑时，其他因素，如肿瘤大小、组织类型和机构，似乎也很重要。然而，在校正了初始表现状态、疾病程度和既往体重减轻的影响后，他们的贡献相对较小。仅根据这三个预后因素，中位生存期从6周到一年以上不等。在不考虑这些预测因素的情况下报告结果，严重阻碍了调查之间可能进行的任何比较。
Seventy-seven prognostic factors were considered in an evaluation of more than 5,000 patients with inoperable bronchogenic carcinoma of the lung; these patients were entered on the Veterans Administration Lung Group protocols 9-15 (1968-78). Fifty prognostic factors for survival were identified, and their relative contributions to patient survival were considered. The three most important prognostic factors affecting survival were the Karnofsky initial performance status score, extent of disease, and weight loss in the previous 6 months. These factors denoted three general prognostic components: current physical status, current disease status, and prior physical status. Initial performance status was the dominant prognostic factor. Characterization of patient's function status with the use of the Karnofsky scale was preferred to a summarized scale or a dichotomization into ambulatory versus nonambulatory. The current practice of dichotomizing factors resulted in the loss of much prognostic information. Other factors, such as tumor size, histologic type, and institution, appeared to be important when considered alone. However, their contribution was relatively minor after a correction was made for the effects of initial performance status, extent of disease, and prior weight loss. Depending on these three prognostic factors alone, median survival varied between 6 weeks and over a year. Reporting of results without the consideration of such prognostic factors severly hampers any comparisons that may be made between investigations.