Si Qi Yoong, Hui Zhang, Dee Whitty, Wilson Wai San Tam, Wenru Wang, Davina Porock
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引用次数: 0
Abstract
Objectives: To evaluate the prognostic utility of Palliative Prognostic Index (PPI) scores in predicting the death of adults with advanced cancer.
Methods: A systematic review and meta-analysis were conducted. Six databases were searched for articles published from inception till 16 February 2024. Observational studies reporting time-to-event outcomes of PPI scores used in any setting, timing and score cutoffs were eligible. Participants were adults with advanced cancer residing in any setting. Random effects meta-analysis was used to pool hazard, risk, or odds ratios. Findings were narratively synthesized when meta-analysis was not possible.
Results: Twenty-three studies (n = 11,235 patients) were included. All meta-analyses found that higher PPI scores or risk categories were significantly associated with death and, similarly, in most narratively synthesized studies. PPI > 6 vs PPI ≤ 4 (pooled adjusted HR = 5.42, 95% confidence intervals [CI] 2.01-14.59, p = 0.0009; pooled unadjusted HR = 5.05, 95% CI 4.10-6.17, p < 0.00001), 4 < PPI ≤ 6 vs PPI ≤ 4 (pooled adjusted HR = 2.04, 95% CI 1.30-3.21, p = 0.002), PPI ≥ 6 vs PPI < 6 (pooled adjusted HR = 2.52, 95% CI 1.39-4.58, p = 0.005), PPI ≤ 4 vs PPI > 6 for predicting inpatient death (unadjusted RR = 3.48, 95% CI 2.46-4.91, p < 0.00001), and PPI as a continuous variable (pooled unadjusted HR = 1.30, 95% CI 1.22-1.38, p < 0.00001) were significant predictors for mortality. Changes in PPI scores may also be useful as a prognostic factor.
Significance of results: A higher PPI score is likely an independent prognostic factor for an increased risk of death, but more research is needed to validate the risk groups as defined by the original development study. Meta-analysis results need to be interpreted cautiously, as only 2-4 studies were included in each analysis. Clinicians and researchers may find this useful for guiding decision-making regarding the suitability of curative and/or palliative treatments and clinical trial design.
目的：评价姑息预后指数（PPI）评分在预测成人晚期癌症患者死亡中的预后效用。方法：进行系统综述和荟萃分析。在六个数据库中检索了从成立到2024年2月16日发表的文章。观察性研究报告了在任何情况下使用的PPI评分的时间到事件的结果，时间和评分截止是合格的。参与者是居住在任何环境中的晚期癌症成年人。随机效应荟萃分析用于汇总危险、风险或优势比。当不能进行meta分析时，对结果进行叙述性综合。结果：纳入23项研究（n = 11,235例患者）。所有荟萃分析发现，较高的PPI评分或风险类别与死亡显著相关，类似地，在大多数叙述性综合研究中也是如此。PPI bbb6.0 vs PPI≤4(合并调整后HR = 5.42, 95%可信区间[CI] 2.01-14.59, p = 0.0009；池未调整HR = 5.05, 95% CI 4.10 - -6.17, p < 0.00001), 4 < PPI≤6 vs PPI≤4(集中调整HR = 2.04, 95% CI 1.30 - -3.21, p = 0.002), PPI≥6 vs PPI < 6(集中调整HR = 2.52, 95% CI 1.39 - -4.58, p = 0.005), PPI≤4 vs PPI > 6预测住院死亡(未经调整的RR = 3.48, 95% CI 2.46 - -4.91, p < 0.00001),和PPI连续变量(汇集未经调整HR = 1.30, 95% CI 1.22 - -1.38, p < 0.00001),死亡率的重要预测因子。PPI评分的变化也可作为一种预后因素。结果的意义：较高的PPI评分可能是死亡风险增加的独立预后因素，但需要更多的研究来验证原始发展研究所定义的风险组。meta分析结果需要谨慎解读，因为每次分析只纳入2-4项研究。临床医生和研究人员可能会发现，这有助于指导有关治疗和/或姑息治疗的适用性和临床试验设计的决策。
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