背景:患者报告的结果测量(PROM)是个体身体功能和情绪健康的自我反映。埃德蒙顿症状评估量表(ESAS)是一种简单且经过验证的PRO工具,包含10种常见症状和患者报告的功能状态(PRFS)度量。该工具在胃食管癌(GEC)患者中的预后价值尚不清楚。在这项研究中,我们检查了GEC患者的ESAS评分与总生存期(OS)之间的关系,ESAS和东部肿瘤协作组(ECOG)的预后差异,并评估PRFS与医生报告的ECOG表现状态(PS)之间的相关性。
方法:本研究是一项回顾性队列研究,纳入了211例患有局部(I-III期)和转移性疾病的GEC患者,这些患者在治疗前至少完成了一次基线ESAS。根据ESAS评分将患者分为3个队列。OS使用Kaplan-Meier方法进行评估,并计算ESAS和医师报告的ECOG的一致性指数(c指数)。还评估了PRFS和医师-ECOG之间的协议。
结果:总计,包括211名患者。中位年龄为60.8岁;90%的患者为ECOGPS0-1;38%的患者为I-III期,而62%为从头转移患者。OS中位数低,中度,高症状负担(SB)患者队列为19.17m,16.39mm,和12.68米,分别(P<.04)。医师-ECOG和ESAS(c指数分别为0.56和0.5753)与PRFS和医师-ECOG(c指数分别为0.5615和0.5545)预测死亡的能力相似。患者和医生之间的PS一致性为50%,加权Kappa为0.27(95%CI:0.17-0.38)。
结论:患者的SB似乎具有预后意义。ESAS和医生报告的ECOG具有相当的预后价值。医生和患者经常对PS有不同的意见。ESAS采取以患者为中心的方法,在实践中应鼓励GEC患者作为预后的附加工具。
BACKGROUND: Patient-reported outcomes measures (PROM) are self-reflections of an individual\'s physical functioning and emotional well-being. The Edmonton Symptom Assessment Scale (ESAS) is a simple and validated PRO tool of 10 common symptoms and a patient-reported functional status (
PRFS) measure. The prognostic value of this tool is unknown in patients with gastroesophageal cancer (GEC). In this study, we examined the association between the ESAS score and overall survival (OS) in patients with GEC, the prognostication difference between ESAS and Eastern Cooperative Oncology Group (ECOG), and assessed the correlation between
PRFS and the physician-reported ECOG performance status (PS).
METHODS: The study was a retrospective cohort study of 211 patients with GEC with localized (stages I-III) and metastatic disease who completed at least one baseline ESAS prior to treatment. Patients were grouped into 3 cohorts based on ESAS score. OS was assessed using the Kaplan-Meier method, and the concordance index (c-index) was calculated for ESAS and physician-reported ECOG. The agreement between
PRFS and physician-ECOG was also assessed.
RESULTS: In total, 211 patients were included. The median age was 60.8 years; 90% of patients were ECOG PS 0-1; 38% of patients were stages I-III, while 62% were de novo metastatic patients. Median OS in low, moderate, high symptom burden (SB) patients\' cohorts was 19.17 m, 16.39 mm, and 12.68 m, respectively (P < .04). The ability to predict death was similar between physician-ECOG and ESAS (c-index 0.56 and 0.5753, respectively) and
PRFS and physician-ECOG (c-index of 0.5615 and 0.5545, respectively). The PS agreement between patients and physicians was 50% with a weighted Kappa of 0.27 (95% CI: 0.17-0.38).
CONCLUSIONS: Patient\'s SB seems to carry a prognostic significance. ESAS and physician-reported ECOG exhibit comparable prognostic values. Physicians and patients can frequently have divergent opinions on PS. ESAS takes a patient-centered approach and should be encouraged in practice among patients with GEC as an additional tool for prognostication.