PO.PS01.09 · 人群科学
使用多机构风险模型评估化疗患者的生存结局：一项回顾性分析
Survival outcomes in chemotherapy patients using a multi-institutional risk model. A retrospective analysis
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：接受化疗的癌症患者因疾病本身以及治疗相关不良事件而具有较高的并发症风险。Chen模型是由圣路易斯Mercy Health开发的一种专有风险分层工具（多变量分析），可识别有不良结局风险的化疗患者。Chen模型将患者分为高风险（评分≥90）、中高风险（80至89）和低风险组（<80）。在我们的多机构分析中，我们旨在识别按Chen模型分层的成年化疗患者（非白血病，年龄>18岁）的6个月和12个月死亡率。
方法：我们对2023年7月至2025年8月在Mercy医院系统接受治疗的18,854名化疗患者进行了回顾性分析，该系统包括横跨三个州（密苏里州、阿肯色州和俄克拉荷马州）的多个医院院区和肿瘤科诊所。患者根据其化疗后7天期间的最大Chen模型评分被分配至各队列。共有2139名患者属于高风险组，2449名属于中高风险组，14266名属于低风险组。采用Kaplan-Meier估计和Cox比例风险模型评估6个月和12个月死亡率，并计算风险比（HR）和95%置信区间（CI）。
结果：高风险组的6个月死亡率为39.96%（95% CI：37.85%-42.14%），中高风险组为22.59%（95% CI：20.91%-24.40%），低风险组为11.65%（95% CI：11.12%-12.21%）。12个月死亡率分别为51.63%（95% CI：49.31%-54.00%）、31.44%（95% CI：29.36%-33.62%）和19.54%（95% CI：18.84%-20.26%）。Cox模型显示，与低风险组相比，高风险组（6个月HR=4.4，12个月HR=3.7；p<0.005）和中高风险组（6个月HR=1.5，12个月HR=1.4；p<0.005）的死亡风险显著升高。对复合姑息治疗和临终关怀服务利用的进一步分析显示，高风险组为23.2%，中高风险组为15.6%。
结论：Chen模型能够有效地按死亡风险对化疗患者进行分层，高风险患者在6个月和12个月时面临明显更差的结局。我们还发现较高风险组的姑息治疗利用率较低。这些发现支持该模型在识别可能从加强监测和早期引入支持性服务（尤其是姑息治疗服务）中获益的患者方面的实用性。仍需进一步研究以验证这些结果并评估针对性干预的影响。
查看英文原文 English abstract
Background: Patients with cancer who are receiving chemotherapy have a high risk of complications due to the disease and from adverse events due to therapy. The Chen Model, a proprietary risk stratification tool (multivariable analysis) developed by Mercy Health, St. Louis, identifies chemotherapy patients at risk for adverse outcomes. The Chen Model stratifies patients into high risk (score>=90), moderate high risk (80 to 89), and low risk groups (<80). From our multi-institutional analysis, we aim to identify the 6- and 12-month mortality rates among adult chemotherapy patients (non-leukemia, age >18) stratified by the Chen model.
Methods: We conducted a retrospective analysis of 18,854 chemotherapy patients treated between July 2023 and August 2025 at the Mercy Hospital system, which includes multiple hospital sites and oncology practices across three states (Missouri, Arkansas, and Oklahoma). Patients were assigned to cohorts based on their maximum Chen model score during the 7-day post-chemotherapy period. A total of 2139 patients were in the high-risk group, 2449 in moderate high-risk, and 14266 in the low-risk group. Kaplan-Meier estimates and Cox proportional hazards models were used to assess 6- and 12-month mortality, with hazard ratios (HR) and 95% confidence intervals (CI) calculated.
Results: Six-month mortality rates were 39.96% (95% CI: 37.85%-42.14%) for the high-risk group, 22.59% (95% CI: 20.91%-24.40%) for the moderate high-risk group, and 11.65% (95% CI: 11.12%-12.21%) for the low-risk group. Twelve-month mortality rates were 51.63% (95% CI: 49.31%-54.00%), 31.44% (95% CI: 29.36%-33.62%), and 19.54% (95% CI: 18.84%-20.26%), respectively. Cox models showed significantly elevated hazard of death for high-risk (HR=4.4 at 6 months, HR=3.7 at 12 months; p<0.005) and moderate high-risk (HR=1.5 at 6 months, HR=1.4 at 12 months; p<0.005) groups compared to the low-risk group. Further analysis on composite palliative care and hospice services utilization was identified to be 23.2% in high risk and 15.6% in moderate high-risk groups.
Conclusions: The Chen model effectively stratifies chemotherapy patients by mortality risk, with high-risk patients facing substantially worse outcomes at 6 and 12 months. We also identified a lower palliative care utility in the higher-risk groups. These findings support the model's utility in identifying patients who may benefit from intensified monitoring and early involvement of supportive services, particularly palliative care services. Further studies are needed to validate these results and assess the impact of targeted interventions.
利益披露 Disclosure
A. Reddy, None..
A. Ashok, None..
Y. Wang, None..
J. Carlson, None.