Patient-Reported Outcomes as Prognostic Indicators for Overall Survival in Cancer: A Systematic Review and Meta-Analysis.

While studies have reported associations between PROs and survival, the prognostic significance of specific PRO domains has not been systematically quantified.

尽管研究已经报道了PROs与生存之间的关联，但特定PRO领域的预后意义尚未系统地量化。

Background

To evaluate the association between baseline PROs and overall survival(OS) in patients with cancer and quantify the prognostic significance of various PRO domains through a systematic reviewand meta-analysisof randomized clinical trials (RCTs).

通过系统评价和随机临床试验(RCTs)的荟萃分析，评估基线患者报告结局(PROs)与癌症患者总生存(OS)之间的关联，并量化各种PRO领域对预后意义的重要性。

data_sources

A systematic literature search of PubMed (MEDLINE), Ovid Embase, and the Cochrane Library was conducted to identify eligible studies published between January 1, 2000, and June 1, 2024.

对PubMed (MEDLINE)、Ovid Embase和Cochrane图书馆进行了系统的文献检索，以确定2000年1月1日至2024年6月1日期间发表的符合条件的研究。

The data were analyzed on January 15, 2025.

数据分析完成于2025年1月15日。

study_selection

Eligible studies were prospective RCTs that enrolled adult patients with cancer (18 years or older) that included at least 1 baseline PRO measure, reported OS as an outcome, and conducted multivariate analyses that adjusted for clinical and disease-related confounders.

符合条件的研究是前瞻性随机对照试验（RCTs），招募了18岁或以上的癌症成人患者，至少包含一项基线患者报告结果（PRO）测量，报告了总生存（OS）作为结果，并进行了调整临床和疾病相关混杂因素的多变量分析。

data_extraction_and_synthesis

Data from eligible RCTs were extracted independently and in duplicate by 4 reviewers.

合格的随机对照试验(RCTs)的数据由4名评审员独立且成对地提取。

Studies using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire were meta-analyzed using a random-effects model with an inverse variance-weighted approach.

使用欧洲癌症研究与治疗组织生活质量问卷的研究通过随机效应模型和逆方差加权方法进行了荟萃分析。

main_outcome_and_measure

The primary outcome was the association between baseline PROs and OS reported using pooled hazard ratios (HRs) and 95% CIs.

主要结果是基线患者报告结局(PROs)与总生存(OS)之间的关联，报告使用了汇总的风险比(HRs)和95%置信区间(CIs)。

Results

A total of 69 RCTs comprising 44 030 patients were included in the systematic review, with 31 RCTs (44.9%) meeting criteria for the meta-analysis.

系统综述共纳入了69项随机对照试验(RCTs)，涵盖44,030名患者，其中31项RCTs (44.9%)符合荟萃分析的纳入标准。

Higher global health status scores and quality of life were associated with improved OS (hazard ratio[HR], 0.99; 95% CI, 0.98-0.99).

更高的全球健康状况评分和生活质量与改善的总生存期相关（风险比[HR]，0.99；95%置信区间，0.98-0.99）。

Among functional scales, physical functioning (HR, 0.94; 95% CI, 0.92-0.96) and role functioning (HR, 0.96; 95% CI, 0.94-0.98) were associated with improved OS.

在功能量表中，躯体功能（HR，0.94；95%置信区间，0.92-0.96）和角色功能（HR，0.96；95%置信区间，0.94-0.98）与改善的总生存期相关。

Conversely, higher symptom burden, including nausea and vomiting (HR, 1.12; 95% CI, 1.04-1.21), fatigue (HR, 1.05; 95% CI, 1.00-1.10), and pain (HR, 1.07; 95% CI, 1.04-1.11), was associated with worse OS.

相反，较高的症状负担，包括恶心和呕吐（HR，1.12；95% CI，1.04-1.21）、疲劳（HR，1.05；95% CI，1.00-1.10）和疼痛（HR，1.07；95% CI，1.04-1.11），与较差的总生存期（OS）相关。

The overall pooled effect demonstrated that increasing individual symptom severity was associated with higher mortality risk (HR, 1.03; 95% CI, 1.01-1.04).

总体汇总效应显示，随着个体症状严重程度的增加，与更高的死亡风险相关（HR，1.03；95% CI，1.01-1.04）。

The Egger test showed no evidence of publication bias.

Egger检验未显示出版偏倚的证据。

conclusions_and_relevance

This systematic reviewand meta-analysisfound that PROs offer independent prognostic information for cancer survival. These findings support the integration of PRO assessments into clinical decision-making and risk stratification in oncology.

这项系统评价和荟萃分析发现，患者报告结果（PROs）为癌症生存提供了独立的预后信息。这些发现支持将PRO评估整合到肿瘤学的临床决策和风险分层中。