Prognostic value of patient-reported symptom interference in patients with late-stage lung cancer
Prognostic value of patient-reported symptom interference in patients with late-stage lung cancer
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DOI：
10.1007/s11136-013-0356-2
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发表时间：
2013-10-01
影响因子：
3.5
通讯作者：
Mendoza, Tito R.
中科院分区：
文献类型：
--
作者：
Barney, Bradley J.;Wang, Xin Shelley;Mendoza, Tito R.
患者报告的预后（PROs）已被发现是临床结果（如总生存期（OS））的重要预测因子，但人口统计学和临床因素对PROs预后能力的影响尚不清楚。从12项简短健康调查（SF-12）和md安德森症状量表（MDASI）中得出的几个PROs与OS的关系进行了调查，并对其他因素进行了调整，包括性能状态。回顾性分析了90例IV期非小细胞肺癌患者的资料。将几个基线PRO添加到基本Cox比例风险模型中，以检验PRO：平均MDASI症状干扰水平对模型拟合的边际显著性和改善；5种选定症状的MDASI症状严重程度均值；SF-12体质和心理成分摘要；SF-12一般健康项目使用自举重采样来评估结果的稳健性。当模型未调整与其他预后因素的相互作用时，MDASI平均干扰水平对OS有显著影响（p = 0.007）。进一步的研究表明，显著性是由于与表现状态的相互作用（p = 0.001）。MDASI平均症状严重程度、SF-12生理成分总结、心理成分总结和一般健康项目对OS无显著影响。即使考虑到人口统计学和临床预后因素，症状干扰也为表现不佳的晚期肺癌患者的OS增加了预后信息。
Patient-reported outcomes (PROs) have been found to be significant predictors of clinical outcomes such as overall survival (OS), but the effect of demographic and clinical factors on the prognostic ability of PROs is less understood. Several PROs derived from the 12-item Short-Form Health Survey (SF-12) and M. D. Anderson Symptom Inventory (MDASI) were investigated for association with OS, with adjustments for other factors, including performance status.A retrospective analysis was performed on data from 90 patients with stage IV non-small cell lung cancer. Several baseline PROs were added to a base Cox proportional hazards model to examine the marginal significance and improvement in model fit attributable to the PRO: mean MDASI symptom interference level; mean MDASI symptom severity level for five selected symptoms; SF-12 physical and mental component summaries; and the SF-12 general health item. Bootstrap resampling was used to assess the robustness of the findings.The MDASI mean interference level had a significant effect on OS (p = 0.007) when the model was not adjusted for interactions with other prognostic factors. Further exploration suggested the significance was due to an interaction with performance status (p = 0.001). The MDASI mean symptom severity level and the SF-12 physical component summary, mental component summary, and general health item did not have a significant effect on OS.Symptom interference adds prognostic information for OS in advanced lung cancer patients with poor performance status, even when demographic and clinical prognostic factors are accounted for.