终末期癌症患者生存期预测工具的研究进展
Research Progress on Survival Prediction Tools for Patients with Terminal Cancer
DOI: 10.12677/acm.2026.1693047, PDF,   
作者: 刘蒙恩, 庞 敏, 盛立军*:山东第一医科大学第三附属医院安宁疗护中心,山东 济南
关键词: 终末期癌症;生存期预测;安宁疗护;预后模型;多维度评估;Terminal Cancer; Survival Prediction; Hospice Care; Prognostic Model; Multidimensional Assessment
摘要: 准确预测终末期癌症患者的生存期是安宁疗护实践中的核心环节,对于优化医疗资源配置、制定个体化照护计划及指导医患沟通具有重要意义。近年来,国内外已发展出多种生存期预测工具,根据其指标构成可分为主观指标量表、客观指标量表、主客观结合量表三大类。本文系统综述各类预测工具的研究进展,重点比较其预测效能,并从多维度理论框架探讨新型预后指标的研究方向,最后展望未来发展趋势,以期为我国安宁疗护实践提供参考。
Abstract: Accurate prediction of survival time in patients with terminal cancer is a core component of hospice care practice, playing a critical role in optimizing healthcare resource allocation, developing individualized care plans, and guiding clinician-patient communication. In recent years, a variety of survival prediction tools have been developed both domestically and internationally. Based on their indicator composition, these tools can be categorized into three major types: subjective indicator scales, objective indicator scales, and combined subjective-objective scales. This article systematically reviews the research progress of various prediction tools, with a focus on comparing their predictive performance, discusses potential directions for novel prognostic indicators within a multidimensional theoretical framework, and finally outlines future development trends, aiming to provide a reference for hospice care practice in China.
文章引用:刘蒙恩, 庞敏, 盛立军. 终末期癌症患者生存期预测工具的研究进展[J]. 临床医学进展, 2026, 16(9): 291-300. https://doi.org/10.12677/acm.2026.1693047

参考文献

[1] Sung, H., Ferlay, J., Siegel, R.L., Laversanne, M., Soerjomataram, I., Jemal, A., et al. (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 71, 209-249.
https://doi.org/10.3322/caac.21660
[2] 提升生命质量 顺应文明发展——全国政协“推进安宁疗护工作”双周协商座谈会发言摘登[EB/OL].
http://www.cppcc.gov.cn/zxww/2016/04/25/ARTI1461545319578654.shtml, 2026‑08‑28.
[3] 国家卫生计生委关于印发安宁疗护中心基本标准和管理规范(试行)的通知: 国卫医发〔2017〕7号[EB/OL].
https://www.nhc.gov.cn/yzygj/c100068/201702/26bf0da4ccd6423992953d45c9bb8279.shtml, 2026-08-12.
[4] 国家卫生计生委办公厅关于印发安宁疗护实践指南(试行)的通知: 国卫办医发〔2017〕5号[EB/OL].
https://www.nhc.gov.cn/yzygj/c100068/201702/3cea53b59f1d454ab9707cf9307a21eb.shtml, 2026-08-12.
[5] 中共中央 国务院印发《“健康中国2030”规划纲要》[EB/OL].
https://www.nhc.gov.cn/guihuaxxs/c100132/201610/cef9821abcfc4544bb27e2bc533bd7cf.shtml, 2026-08-12.
[6] Pradhani, G. and Gogoi, J. (2025) Advancements in Cancer Survival Prediction: A Systematic Review of Classical and Modern Approaches. Indian Journal of Community Medicine, 50, S333-S343.
https://doi.org/10.4103/ijcm.ijcm_626_24
[7] Hui, D., Paiva, C.E., Del Fabbro, E.G., Steer, C., Naberhuis, J., van de Wetering, M., et al. (2019) Prognostication in Advanced Cancer: Update and Directions for Future Research. Supportive Care in Cancer, 27, 1973-1984.
https://doi.org/10.1007/s00520-019-04727-y
[8] Hiratsuka, Y., Hamano, J., Mori, M., Suh, S. and Hui, D. (2025) Prognostication in Advanced Cancer: Foreseeing from Global Insights and Foretelling in the Asian Context. Japanese Journal of Clinical Oncology, 55, 991-999.
https://doi.org/10.1093/jjco/hyaf090
[9] Salvador Comino, M.R., Youssef, P., Heinzelmann, A., Bernhardt, F., Seifert, C. and Tewes, M. (2024) Machine Learning-Based Prediction of 1-Year Survival Using Subjective and Objective Parameters in Patients with Cancer. JCO Clinical Cancer Informatics, 8, e2400041.
https://doi.org/10.1200/cci.24.00041
[10] Maltoni, M., Caraceni, A., Brunelli, C., Broeckaert, B., Christakis, N., Eychmueller, S., et al. (2005) Prognostic Factors in Advanced Cancer Patients: Evidence-Based Clinical Recommendations—A Study by the Steering Committee of the European Association for Palliative Care. Journal of Clinical Oncology, 23, 6240-6248.
https://doi.org/10.1200/jco.2005.06.866
[11] Farrar, A., Smith, J., Allchin, M., et al. (2015) Multidisciplinary Prognostication Using the Palliative Prognostic Score in an Australian Cancer Center. Palliative Care Research and Treatment, 9, 7-14.
https://doi.org/10.4137/PCRT.S24411
[12] Maltoni, M., Nanni, O., Pirovano, M., Scarpi, E., Indelli, M., Martini, C., et al. (1999) Successful Validation of the Palliative Prognostic Score in Terminally Ill Cancer Patients. Journal of Pain and Symptom Management, 17, 240-247.
https://doi.org/10.1016/s0885-3924(98)00146-8
[13] Fung, M.Y., Wong, Y.L., Cheung, K.M., Bao, K.H.K. and Sung, W.W.Y. (2025) Prognostic Models for Survival Predictions in Advanced Cancer Patients: A Systematic Review and Meta-Analysis. BMC Palliative Care, 24, Article No. 54.
https://doi.org/10.1186/s12904-025-01696-4
[14] Karnofsky, D.A. and Burchenal, J.H. (1949) The Clinical Evaluation of Chemotherapeutic Agents in Cancer. In: Macleod, C.M., Ed., Evaluation of Chemotherapeutic Agents, Columbia University Press, 191‑205.
[15] Yates, J.W., Chalmer, B. and McKegney, F.P. (1980) Evaluation of Patients with Advanced Cancer Using the Karnofsky Performance Status. Cancer, 45, 2220-2224.
https://doi.org/10.1002/1097-0142(19800415)45:8<2220::aid-cncr2820450835>3.0.co;2-q
[16] Hwang, S.S., Scott, C.B., Chang, V.T., Cogswell, J., Srinivas, S. and Kasimis, B. (2004) Prediction of Survival for Advanced Cancer Patients by Recursive Partitioning Analysis: Role of Karnofsky Performance Status, Quality of Life, and Symptom Distress. Cancer Investigation, 22, 678-687.
https://doi.org/10.1081/cnv-200032911
[17] Anderson, F., Downing, G.M., Hill, J., Casorso, L. and Lerch, N. (1996) Palliative Performance Scale (PPS): A New Tool. Journal of Palliative Care, 12, 5-11.
https://doi.org/10.1177/082585979601200102
[18] Baik, D., Russell, D., Jordan, L., Dooley, F., Bowles, K.H. and Masterson Creber, R.M. (2018) Using the Palliative Performance Scale to Estimate Survival for Patients at the End of Life: A Systematic Review of the Literature. Journal of Palliative Medicine, 21, 1651-1661.
https://doi.org/10.1089/jpm.2018.0141
[19] Kim, E., Lee, J., Kim, M., Noh, H. and Jin, Y. (2014) Validation of the Prognosis in Palliative Care Study Predictor Models in Terminal Cancer Patients. Korean Journal of Family Medicine, 35, 283-294.
https://doi.org/10.4082/kjfm.2014.35.6.283
[20] Linklater, G., Lawton, S., Fielding, S., Macaulay, L., Carroll, D. and Pang, D. (2012) Introducing the Palliative Performance Scale to Clinicians: The Grampian Experience. BMJ Supportive & Palliative Care, 2, 121-126.
https://doi.org/10.1136/bmjspcare-2011-000133
[21] Babcock, M., Gould Kuntz, J., Kowalsky, D., Calitri, N. and Kenny, A.M. (2016) The Palliative Performance Scale Predicts Three-and Six-Month Survival in Older Adult Patients Admitted to the Hospital through the Emergency Department. Journal of Palliative Medicine, 19, 1087-1091.
https://doi.org/10.1089/jpm.2016.0011
[22] Morita, T., Tsunoda, J., Inoue, S. and Chihara, S. (1999) The Palliative Prognostic Index: A Scoring System for Survival Prediction of Terminally Ill Cancer Patients. Supportive Care in Cancer, 7, 128-133.
https://doi.org/10.1007/s005200050242
[23] Yoong, S.Q., Zhang, H., Whitty, D., Tam, W.W.S., Wang, W. and Porock, D. (2025) Prognostic Utility of Palliative Prognostic Index in Advanced Cancer: A Systematic Review and Meta-Analysis. Palliative and Supportive Care, 23, e80.
https://doi.org/10.1017/s1478951525000021
[24] Kao, C., Hung, Y., Wang, H., Chen, J., Chin, T., Lu, C., et al. (2014) Combination of Initial Palliative Prognostic Index and Score Change Provides a Better Prognostic Value for Terminally Ill Cancer Patients: A Six-Year Observational Cohort Study. Journal of Pain and Symptom Management, 48, 804-814.
https://doi.org/10.1016/j.jpainsymman.2013.12.246
[25] Lingjun, Z., Jing, C., Jian, L., Wee, B. and Jijun, Z. (2009) Prediction of Survival Time in Advanced Cancer: A Prognostic Scale for Chinese Patients. Journal of Pain and Symptom Management, 38, 578-586.
https://doi.org/10.1016/j.jpainsymman.2008.12.005
[26] Zhou, J., Xu, S., Cao, Z., Tang, J., Fang, X., Qin, L., et al. (2020) Validation of the Palliative Prognostic Index, Performance Status-Based Palliative Prognostic Index and Chinese Prognostic Scale in a Home Palliative Care Setting for Patients with Advanced Cancer in China. BMC Palliative Care, 19, Article No. 167.
https://doi.org/10.1186/s12904-020-00676-0
[27] Gwilliam, B., Keeley, V., Todd, C., Gittins, M., Roberts, C., Kelly, L., et al. (2015) Development of Prognosis in Palliative Care Study (PiPS) Predictor Models to Improve Prognostication in Advanced Cancer: Prospective Cohort Study. BMJ Supportive & Palliative Care, 5, 390-398.
https://doi.org/10.1136/bmjspcare-2012-d4020rep
[28] Stone, P.C., Kalpakidou, A., Todd, C., Griffiths, J., Keeley, V., Spencer, K., et al. (2021) The Prognosis in Palliative Care Study II (PiPS2): A Prospective Observational Validation Study of a Prognostic Tool with an Embedded Qualitative Evaluation. PLOS ONE, 16, e0249297.
https://doi.org/10.1371/journal.pone.0249297
[29] Zeng, L., Zhang, L., Culleton, S., Jon, F., Holden, L., Kwong, J., et al. (2011) Edmonton Symptom Assessment Scale as a Prognosticative Indicator in Patients with Advanced Cancer. Journal of Palliative Medicine, 14, 337-342.
https://doi.org/10.1089/jpm.2010.0438
[30] Dai, W.F., Beca, J., Guo, H., Isaranawatchai, W., Schwartz, D., Naipaul, R., et al. (2020) Are Population‐Based Patient‐Reported Outcomes Associated with Overall Survival in Patients with Advanced Pancreatic Cancer? Cancer Medicine, 9, 215-224.
https://doi.org/10.1002/cam4.2704
[31] Forrest, L.M., McMillan, D.C., McArdle, C.S., Angerson, W.J. and Dunlop, D.J. (2003) Evaluation of Cumulative Prognostic Scores Based on the Systemic Inflammatory Response in Patients with Inoperable Non-Small-Cell Lung Cancer. British Journal of Cancer, 89, 1028-1030.
https://doi.org/10.1038/sj.bjc.6601242
[32] Forrest, L.M., McMillan, D.C., McArdle, C.S., Angerson, W.J., Dagg, K. and Scott, H.R. (2005) A Prospective Longitudinal Study of Performance Status, an Inflammation-Based Score (GPS) and Survival in Patients with Inoperable Non-Small-Cell Lung Cancer. British Journal of Cancer, 92, 1834-1836.
https://doi.org/10.1038/sj.bjc.6602591
[33] Miura, T., Matsumoto, Y., Hama, T., Amano, K., Tei, Y., Kikuchi, A., et al. (2015) Glasgow Prognostic Score Predicts Prognosis for Cancer Patients in Palliative Settings: A Subanalysis of the Japan-Prognostic Assessment Tools Validation (J-ProVal) Study. Supportive Care in Cancer, 23, 3149-3156.
https://doi.org/10.1007/s00520-015-2693-x
[34] Templeton, A.J., McNamara, M.G., Šeruga, B., Vera-Badillo, F.E., Aneja, P., Ocaña, A., et al. (2014) Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Solid Tumors: A Systematic Review and Meta-Analysis. JNCI: Journal of the National Cancer Institute, 106, dju124.
https://doi.org/10.1093/jnci/dju124
[35] Peng, J., Chen, H., Chen, Z., Tan, J., Wu, F. and Li, X. (2025) Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients with Hepatocellular Carcinoma Receiving Curative Therapies: A Systematic Review and Meta-Analysis. BMC Cancer, 25, Article No. 571.
https://doi.org/10.1186/s12885-025-13972-w
[36] Geissbühler, P., Mermillod, B. and Rapin, C. (2000) Elevated Serum Vitamin B12 Levels Associated with CRP as a Predictive Factor of Mortality in Palliative Care Cancer Patients: A Prospective Study over Five Years. Journal of Pain and Symptom Management, 20, 93-103.
https://doi.org/10.1016/s0885-3924(00)00169-x
[37] Montegut, C., Correard, F., Nouguerède, E., Rey, D., Chevalier, T., Meurer, M., et al. (2022) Prognostic Value of the B12/CRP Index in Older Systemically Treatable Cancer Patients. Cancers, 14, Article No. 169.
https://doi.org/10.3390/cancers14010169
[38] Glare, P. and Virik, K. (2001) Independent Prospective Validation of the Pap Score in Terminally Ill Patients Referred to a Hospital-Based Palliative Medicine Consultation Service. Journal of Pain and Symptom Management, 22, 891-898.
https://doi.org/10.1016/s0885-3924(01)00341-4
[39] Scarpi, E., Maltoni, M., Miceli, R., Mariani, L., Caraceni, A., Amadori, D., et al. (2011) Survival Prediction for Terminally Ill Cancer Patients: Revision of the Palliative Prognostic Score with Incorporation of Delirium. The Oncologist, 16, 1793-1799.
https://doi.org/10.1634/theoncologist.2011-0130
[40] Poelzer, A., Baracos, V.E., Sellick, M., Watanabe, S.M., Chabassol, A. and Tarumi, Y. (2026) Evaluation of the Palliative Prognostic Score (PaP) in a Cancer Center-Based Palliative Care Clinic. Journal of Pain and Symptom Management, 71, e464-e470.
https://doi.org/10.1016/j.jpainsymman.2025.12.027
[41] Suh, S., Choi, Y.S., Shim, J.Y., Kim, Y.S., Yeom, C.H., Kim, D., et al. (2010) Construction of a New, Objective Prognostic Score for Terminally Ill Cancer Patients: A Multicenter Study. Supportive Care in Cancer, 18, 151-157.
https://doi.org/10.1007/s00520-009-0639-x
[42] Yoon, S.J., Suh, S., Lee, Y.J., Park, J., Hwang, S., Lee, S.S., et al. (2017) Prospective Validation of Objective Prognostic Score for Advanced Cancer Inpatients in South Korea: A Multicenter Study. Journal of Palliative Medicine, 20, 65-68.
https://doi.org/10.1089/jpm.2016.0044
[43] Jho, H.J., Suh, S., Yoon, S., Lee, S.S., Ahn, H., Yamaguchi, T., et al. (2016) Prospective Validation of the Objective Prognostic Score for Advanced Cancer Patients in Diverse Palliative Settings. Journal of Pain and Symptom Management, 52, 420-427.
https://doi.org/10.1016/j.jpainsymman.2016.03.015
[44] Stone, P.C., Chu, C., Todd, C., Griffiths, J., Kalpakidou, A., Keeley, V., et al. (2022) The Accuracy of Clinician Predictions of Survival in the Prognosis in Palliative Care Study II (PiPS2): A Prospective Observational Study. PLOS ONE, 17, e0267050.
https://doi.org/10.1371/journal.pone.0267050
[45] Durand, J., Mir, O., Coriat, R., Cessot, A., Pourchet, S. and Goldwasser, F. (2011) Validation of the Cochin Risk Index Score (CRIS) for Life Expectancy Prediction in Terminally Ill Cancer Patients. Supportive Care in Cancer, 20, 857-864.
https://doi.org/10.1007/s00520-011-1163-3
[46] McMillan, D.C. (2013) The Systemic Inflammation-Based Glasgow Prognostic Score: A Decade of Experience in Patients with Cancer. Cancer Treatment Reviews, 39, 534-540.
https://doi.org/10.1016/j.ctrv.2012.08.003
[47] Zhu, L., Kong, Y., Xing, Y. and Wang, M. (2025) The Prognostic and Early Efficacy Prediction Value of Baseline C-Reactive Protein-Albumin-Lymphocyte (CALLY) Index in Advanced Pancreatic Cancer. International Journal of General Medicine, 18, 3363-3372.
https://doi.org/10.2147/ijgm.s529776
[48] Mikkelsen, M.K., Lindblom, N.A.F., Dyhl-Polk, A., Juhl, C.B., Johansen, J.S. and Nielsen, D. (2022) Systematic Review and Meta-Analysis of C-Reactive Protein as a Biomarker in Breast Cancer. Critical Reviews in Clinical Laboratory Sciences, 59, 480-500.
https://doi.org/10.1080/10408363.2022.2050886
[49] Fujimura, R., Yaegashi, H., Nakagawa, R., Kamijima, T., Kano, H., Makino, T., et al. (2025) Dynamic Changes in Albumin and Systemic Immune-Inflammation Index as Prognostic Markers in Patients Treated with Cabozantinib after Immune Checkpoint Inhibitors for Metastatic Renal Cell Carcinoma. Cancers, 17, Article No. 3956.
https://doi.org/10.3390/cancers17243956
[50] Lee, Y.J., Hwang, S.-Y., Kim, S.H. and Choi, Y.S. (2025) Low Serum Creatinine as Well as High Serum Creatinine Is Associated with Prognosis of Patients with Cancer in End-of-Life. Korean Journal of Family Medicine, 46, 70-76.
https://doi.org/10.4082/kjfm.23.0116
[51] Feng, J., Wang, L., Yang, X. and Chen, Q. (2025) Serum Creatinine to Cystatin C Ratio Is a Prognostic Indicator in Esophageal Squamous Cell Carcinoma Receiving Neoadjuvant Immunochemotherapy. Frontiers in Immunology, 16, Article ID: 1645874.
https://doi.org/10.3389/fimmu.2025.1645874
[52] Hanna, P.E., Ouyang, T., Tahir, I., Katz‐Agranov, N., Wang, Q., Mantz, L., et al. (2024) Sarcopenia, Adiposity and Large Discordance between Cystatin C and Creatinine‐Based Estimated Glomerular Filtration Rate in Patients with Cancer. Journal of Cachexia, Sarcopenia and Muscle, 15, 1187-1198.
https://doi.org/10.1002/jcsm.13469
[53] Alabbasi, A., Alzahrani, M., Sultan, F. and Sayes, M. (2026) Artificial Intelligence-Powered Predictive Tools to Improve End-of-Life Decision-Making: Mini-Review. BMJ Supportive & Palliative Care, 16, 558-564.
https://doi.org/10.1136/spcare-2025-006066
[54] Nalela, P., Rao, D. and Rao, P. (2026) Explainable AI for Predicting Mortality Risk in Metastatic Cancer: Retrospective Cohort Study Using the Memorial Sloan Kettering-Metastatic Dataset. JMIR Cancer, 12, e74196.
https://doi.org/10.2196/74196