論文No3978
Functional resilience and overall survival in adults treated for advanced non-small-cell lung cancer
Carolyn J. Presley,Joy Tang,Jason Benedict,...Ashley Davenport,Peter G. Shields,Barbara L. Andersen
LUNG CANCER, Volume 196, 107953, October 2024.
＜要約＞
この研究は、進行した肺がんの患者さんの治療中に、身体機能がどのように変化するかを詳しく調べたものです。
具体的には、治療前の身体機能の状態が、治療後の生存期間や身体機能の回復にどのように影響するかを分析しました。
研究の結果、以下のことが明らかになりました。
治療前の身体機能: 治療開始前の身体機能が良好な患者さんは、治療後の生存期間が長い傾向がありました。
機能の回復: 一部の患者さんは治療中に身体機能が回復しましたが、すべての患者さんが回復するわけではありませんでした。
ECOG PSとの比較: 一般的に使われるECOG PSよりも、より詳細な身体機能評価であるmEQ-5D-5Lスコアの方が、生存期間や機能回復の予測に役立つ可能性が示唆されました。
take home message
進行した肺がんの患者さんにとって、治療前の身体機能の状態は非常に重要です。
治療前の身体機能が良い患者さんは、生存期間が長い傾向があります。
治療中に身体機能が回復する患者さんもいますが、全員が回復するわけではありません。
治療効果を予測する際には、ECOG PSだけでなく、より詳細な身体機能評価も考慮する必要があるかもしれません。
Purpose
As more treatments emerge for advanced, stage IV non-small-cell lung cancer (NSCLC), oncologists have difficulty predicting functional resiliency versus functional decline throughout cancer treatment. Our study evaluates functional resilience among patients with advanced NSCLC.
Methods
Functional status was evaluated through 12 months of follow-up based on disability score using the modified EQ-5D-5L (mEQ-5D-5L) survey. Participants were classified into 4 groups: functional maintenance, decline, resilient, or variable. Characteristics of 207 participants with newly diagnosed NSCLC included demographics, comorbidities, baseline Eastern Cooperative Oncology Group (ECOG) performance status (PS), mEQ-5D-5L scores, psychological symptoms, and lung cancer-specific symptoms. Treatment toxicity and grade were recorded. Resilience was defined as improvement from baseline disability scores. A 1-point increase in functional status score represents a 0.5 standard deviation change on the mEQ-5D-5L. Differences between the 4 groups were determined through Fisher’s exact test or ANOVA. Kaplan-Meier curves describe overall survival (baseline through 18 months) stratified by baseline mEQ-5D-5L scores.
Results
Among participants, 42.0 % maintained functional status, 37.7 % experienced functional decline, 10.6 % were resilient, and 9.7 % had variable functional status. Participants with the best baseline function (score of 0) had the longest overall survival and participants with the worst baseline function (score of 5 + ) had the shortest overall survival. Among the healthiest patients, early score increases indicated shorter overall survival. Baseline ECOG PS was not associated with overall survival (p = 0.47).
Conclusion
Baseline functional status may help better predict functional resiliency and overall survival than ECOG PS among patients receiving treatment for advanced NSCLC.