乳腺癌化疗患者症状群及前哨症状的范围综述

Symptom Clusters and Sentinel Symptoms in Breast Cancer Patients Receiving Chemotherapy: A Scoping Review

摘要: 目的：对化疗期间的乳腺癌患者症状群及前哨症状的相关研究进行范围综述。方法：系统检索PubMed、Cochrane Library、Web of Science、Embase、中国知网、维普、万方和中国生物医学文献数据库中相关研究，检索时限为建库至2025年12月20日。结果：共检索文献4802篇，纳入27篇文献，症状评估工具以记忆症状评估量表、安德森症状评估量表及欧洲癌症研究与治疗组织生活质量核心量表为主；症状群识别以探索性因子分析和主成分分析法为主，前哨症状识别主要采用基于Apriori算法的关联规则分析及主变量分析法。前哨症状呈现“一对多”预警模式且具有症状群特异性：食欲下降为消化道症状群的前哨症状，疼痛为疲乏症状群的前哨症状，情绪低落为情感症状群的前哨症状，脱发为病感症状群的前哨症状。前哨症状随乳腺癌患者化疗进程发生阶段性转换：化疗早期以焦虑为先导，中期转向食欲缺乏/恶心与疼痛，后期/间歇期以情绪低落和疼痛为主。结论：乳腺癌化疗患者症状群及前哨症状的识别方法呈多样化特征，亟需方法学规范。前哨症状对症状群的早期预警与精准干预具有重要的临床价值。未来研究应着力于建立统一的识别方法学框架、开展以前哨症状为靶点的纵向因果验证与干预转化研究。

Abstract: Objective: To conduct a scoping review of studies on symptom clusters and sentinel symptoms in breast cancer patients during chemotherapy. Methods: Relevant studies were retrieved from PubMed, Cochrane Library, Web of Science, Embase, CNKI, VIP, Wanfang Data, and the China Biomedical Literature Database (CBM), with the search period set from inception to December 20, 2025. Results: A total of 4802 records were identified, of which 27 were finally included. The most commonly used symptom assessment tools were the Memorial Symptom Assessment Scale (MSAS), the M. D. Anderson Symptom Inventory (MDASI), and the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30). Symptom clusters were mainly identified using exploratory factor analysis and principal component analysis, while sentinel symptoms were primarily identified through association rule analysis based on the Apriori algorithm and principal variable analysis. Sentinel symptoms exhibited a “one-to-many” early-warning pattern with symptom-cluster specificity: loss of appetite served as the sentinel symptom for the gastrointestinal symptom cluster, pain for the fatigue-related symptom cluster, low mood for the emotional symptom cluster, and alopecia for the illness-perception symptom cluster. Furthermore, sentinel symptoms showed stage-wise transitions over the chemotherapy progresses in breast cancer patients: anxiety predominates in the early stages of chemotherapy; in the middle stages, the symptoms shift to loss of appetite, nausea, and pain; and in the late stages or during breaks in treatment, low mood and pain are the primary symptoms. Conclusion: The methods used to identify symptom clusters and sentinel symptoms in breast cancer chemotherapy patients are diverse, highlighting an urgent need for methodological standardization. Sentinel symptoms hold significant clinical value for early warning and precise intervention in symptom clusters. Future research should focus on establishing a unified methodological framework for identification and on conducting longitudinal causal validation and translational intervention studies targeting sentinel symptoms.