Background: Accurate prognostication is essential for clinical decision-making in palliative radiotherapy (RT). The Palliative Performance Scale (PPS) is a validated tool for assessing functional status and estimating survival in palliative care, yet its prognostic value in patients receiving palliative RT for bone metastases remains insufficiently explored. This study aimed to evaluate the association between PPS and overall survival (OS) in a real-world cohort of cancer patients undergoing palliative RT. Methods: This retrospective, single-center study included 153 patients who received palliative RT for bone metastases between 2021 and 2025 at the Department of Radiation Oncology, University Hospital Halle (Saale), Germany. Clinical, demographic, and treatment data were extracted from institutional databases. The primary endpoint was OS, defined as the time from the end of RT to death. Univariable and multivariable Cox proportional hazards regression models were used to identify prognostic factors associated with OS, including PPS, sex, age, marital status, BMI, Charlson Comorbidity Index (CCI), and RT completion. Due to violation of the proportional hazards assumption, PPS (<60% vs. ≥60%) was used as a stratification factor in the final Cox model. Logistic regression was performed to explore predictors of discharge to home. Results: The median OS for the entire cohort was 108 days (3.6 months; 95% CI 78–143 days). Male sex (HR 1.61, 95% CI 1.06–2.46,p= 0.027) and older age (HR 0.98, 95% CI 0.96–1.00,p= 0.050) were associated with shorter survival, whereas completion of the prescribed RT course was strongly associated with improved OS (HR 0.06, 95% CI 0.03–0.12,p< 0.001). Patients with PPS ≥60% had significantly better survival compared to those with lower PPS (HR 0.62, 95% CI 0.41–0.93,p= 0.021). After stratification by PPS, no violation of the proportional hazards assumption was detected (globalp= 0.55). The stratified model confirmed that male sex, age, and RT completion remained independent predictors of survival. No significant predictors were identified for discharge destination in logistic regression analysis. Conclusions: The PPS is a valuable prognostic tool for patients receiving palliative RT for bone metastases. A PPS of ≥60% was associated with prolonged survival, supporting its use in clinical prognostication and treatment planning. Completion of RT emerged as a strong independent predictor of survival, underscoring the importance of treatment adherence even in palliative settings. Stratification by PPS further improved model validity and prognostic accuracy.
背景：在姑息性放疗的临床决策中，准确的预后评估至关重要。姑息功能状态量表是一种经过验证的工具，用于评估姑息治疗患者的功能状态和预估生存期，但其在接受姑息性放疗的骨转移患者中的预后价值尚未得到充分探讨。本研究旨在评估真实世界中接受姑息性放疗的癌症患者其PPS评分与总生存期之间的关联。 方法：这项回顾性单中心研究纳入了2021年至2025年间在德国哈勒（萨勒）大学医院放射肿瘤科接受姑息性放疗的153例骨转移患者。临床、人口统计学和治疗数据均从机构数据库中提取。主要终点是总生存期，定义为从放疗结束到死亡的时间。采用单变量和多变量Cox比例风险回归模型分析与OS相关的预后因素，包括PPS、性别、年龄、婚姻状况、BMI、查尔森合并症指数和放疗完成情况。由于违反了比例风险假设，最终Cox模型中将PPS（<60% vs. ≥60%）用作分层因素。采用逻辑回归分析探讨出院回家的预测因素。 结果：整个队列的中位OS为108天（3.6个月；95% CI 78–143天）。男性（HR 1.61，95% CI 1.06–2.46，p=0.027）和年龄较大（HR 0.98，95% CI 0.96–1.00，p=0.050）与较短的生存期相关，而完成预定的放疗疗程与改善的OS显著相关（HR 0.06，95% CI 0.03–0.12，p<0.001）。PPS≥60%的患者生存期显著优于PPS较低的患者（HR 0.62，95% CI 0.41–0.93，p=0.021）。按PPS分层后，未检测到违反比例风险假设的情况（全局p=0.55）。分层模型证实，男性、年龄和放疗完成情况仍是生存的独立预测因素。在逻辑回归分析中，未发现出院目的地的显著预测因素。 结论：PPS是骨转移患者接受姑息性放疗时一个有价值的预后工具。PPS≥60%与更长的生存期相关，支持其在临床预后评估和治疗计划中的应用。完成放疗是生存的一个强有力的独立预测因素，强调了即使在姑息治疗中坚持治疗的重要性。按PPS分层进一步提高了模型的有效性和预后准确性。
肿瘤(癌症)患者之家