Page 87 - 中国全科医学2022-07

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【Abstract】 Background Accurately predicting the survival period of patients with advanced cancer can not only
lay the foundation for palliative care centers to regulate the admission of patients and provide standardized services，but also
help reduce "meaningless" over-treatment in the process of palliative care.However，there is still a lack of comparative study on
the common survival prediction scales in China. Objective To compare the accuracy of the End-of-life Assessment Form and
common survival prediction scale〔Palliative Prognostic Index（PPI）、Palliative Performance Scale（PPS）、Karnofsky Score
（KPS）〕in predicting the survival of patients with advanced malignant tumors，in order to provide a basis for the selection of
survival prediction tools for advanced cancer patients. Methods Patients with advanced malignant tumors admitted to the hospice
ward of Linfen Road Community Health Service Center of Jing'an Distirct of Shanghai from April 1，2018 to February 1，2020
were retrospectively selected as researchsubjects. At the time of admission，the general information questionnaire，End-of-life
Assessment Form，PPI，PPS，KPS were used to evaluate the patient，and the survival time of the patient was observed and
recorded（from admission to the date of death）. The survival time of all patients was analyzed by Kaplan-Meier method，and
the survival curve was drawn. The Kaplan-Meier method was used to calculate the median survival of patients in different groups
of each scale，the log-rank test was used to compare the differences in survival among patients in different groups of each scale，
and the survival curves were drawn. Finally，by comparing the predicted survival time and the actual survival time of patients with
different score segments of each scale，the accuracy rate of the End-of-life Assessment Form，PPI，PPS and KPS in predicting
the survival time of patients with advanced malignant tumors were calculated. Results A total of 315 patients with advanced
malignant tumors were included in this study，of which 266（84.4%）patients died during hospitalization and 49（15.6%）
patients were censored（right censored，type Ⅲ censored）. The median survival time of 315 patients was 10.00〔95%CI（8.10，
11.90）〕d. The median survival time of patients in groups of 20.0~35.0 points，35.5~45.0 points，45.5~50.0 points，50.5~60.0
points and 60.0~100.0 points of the End-of-life Assessment Form were 1.00〔95%CI（0.79，1.22）〕d，5.00〔95%CI（3.92，
2
6.08）〕d，10.00〔95%CI（7.83，12.17）〕d，22.00〔95%CI（18.42，25.58〕d and 45.00〔95%CI（26.23，63.77〕d（χ =360.561，
P<0.001），respectively；The median survival time of patients in groups of 10~20 points，30~40 points and 50~100 points of
2
KPS were 1.00〔95%CI（0.66，1.34）〕d、7.00〔95%CI（5.23，8.77）〕d and 30.00〔95%CI（20.87，39.13）〕d（χ =137.280，
P<0.001），respectively；The median survival time of patients in groups of 60%~100%，30%~50% and 10%~20% of PPS were
2
35.00〔95%CI（25.90，44.10）〕d、12.00〔95%CI（9.66，14.34）〕d and 2.00〔95%CI（0.85，3.15）〕d（χ =139.311，
P<0.001），respectively；The median survival time of patients in groups of 0~3.5 points，4.0~5.5 points，6.0~7.5 points，8.0~10.0
points and 10.5~15.0 points of PPI were 33.00〔95%CI（25.39，40.61）〕d、12.00〔95%CI（8.15，15.85）〕d、6.00〔95%CI
2
（4.72，7.28）〕d、3.00〔95%CI（1.76，4.24）〕d and 1.00〔95%CI（0.89，1.11）〕d（χ =289.831，P<0.001），
respectively. The accuracy rate of the End-of-life Assessment Form，KPS，PPS and PPI to predict the survival time were 81.27%
（256/315）、57.78%（182/315）、57.46%（181/315）、73.65%（232/315），respectively. Conclusion The End-of-
life Assessment Form，PPI，KPS and PPS can be used to predict the survival time of advanced malignant tumors，but the End-
of-life Assessment Form is superior to PPI，KPS and PPS in predicting the survival time of advanced malignant tumors.
【Key words】 Advanced cancer patients；Survival period；Prediction；Hospice care

安宁疗护是在疾病终末期患者临终前，通过控制其 伯根等 ［7］ 于 2009 年研制的一种可用于预测临终患者生
痛苦和不适症状，并为其提供身体、心理、精神等方面 存期的工具，已被证明具有良好的信效度 ［8］ ，其在我
的照料和人文关怀等服务，进而提高其生命质量，帮助 国临终患者中的适用性较强，并且与国外常见的临终患
其舒适、安详、有尊严地离世 ［1］ 。目前，安宁疗护中 者生存期预测工具相比，所涉及的临床症状指标更为全
心收治的多为生存期较短的癌症晚期患者。准确预测癌 面，更能准确地反映患者的临终状态。迄今，国内关于
症晚期患者的生存期，不仅能为安宁疗护中心规范收治 不同生存期预测量表对癌症晚期患者生存期预测效果的
患者、提供规范化服务奠定基础，还有助于减少安宁疗 比较研究较少，尚不知何种量表在我国癌症晚期患者中
护过程中“无意义”的过度治疗 ［2］ 。国外研究人员已 的适用性更强。本研究拟通过对在社区卫生服务中心接
开发了多种工具用于预测临终患者的生存期，如姑息功 受安宁疗护服务的癌症晚期患者进行观察，比较临终患
能评价量表（PPS） ［3］ 、姑息预后评分（PaP） ［4］ 、姑 者病情评估表、KPS、PPS 及 PPI 在预测癌症晚期患者
［5］
息预后指数（PPI） 等。其中 PPS、PPI 为症状评估量表， 生存期中的准确性，旨在为癌症晚期患者生存期预测工
PaP 为基于临床表现和实验室检查构建的量表。卡氏评 具的遴选提供依据。
分（KPS）可用于评价肿瘤患者的生活质量，也可用于 1 对象与方法
其生存期的预测 ［6］ 。临终患者病情评估表是由我国毛 1.1 研究对象 本研究为回顾性研究，选取 2018 年 4