Background The Palliative Prognostic Score (PaP) is the most widely validated prognostic tool for cancer survival prediction, with modified versions available. A systematic evaluation of PaP tools is lacking. This systematic review and meta-analysis aimed to evaluate the performance and prognostic utility of PaP, Delirium-PaP (D-PaP), and PaP without clinician prediction in predicting 30-day survival of cancer patients and compare their performance. Methods Six databases were searched for peer-reviewed studies and grey literature published from inception till 2/6/2023. English studies must assess PaP, D-PaP, or PaP without clinician predicted survival for 30-day survival in adults ≥18 years old with any stage or type of cancer. Outcomes were pooled using the random effects model or summarised narratively when meta-analysis was not possible. Results Thirty-nine studies (n = 10,617 patients) were included. PaP is an accurate prognostic tool (pooled AUC = 0.82, 95% CI 0.79-0.84) and outperforms PaP without clinician predicted survival (pooled AUC = 0.74, 95% CI 0.71-0.78), suggesting that the original PaP should be preferred. The meta-analysis found PaP and D-PaP performance to be comparable. Most studies reported survival probabilities corresponding to the PaP risk groups, and higher risk groups were significantly associated with shorter survival. Conclusions PaP is a validated prognostic tool for cancer patients that can enhance clinicians' confidence and accuracy in predicting survival. Future studies should investigate if accuracy differs depending on clinician characteristics. Reporting of validation studies must be improved, as most studies were at high risk of bias, primarily because calibration was not assessed.

中文翻译：

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癌症患者生存预测的姑息预后评分：系统评价和荟萃分析

背景 姑息性预后评分 (PaP) 是最广泛验证的癌症生存预测预后工具，并有修改版本。缺乏对 PaP 工具的系统评估。这项系统评价和荟萃分析旨在评估 PaP、Delirium-PaP (D-PaP) 和无临床医生预测的 PaP 在预测癌症患者 30 天生存方面的表现和预后效用，并比较它们的表现。方法 检索六个数据库，查找从开始到 2023 年 2 月 6 日发表的同行评审研究和灰色文献。英国研究必须评估 ≥18 岁患有任何阶段或类型癌症的成人的 30 天生存期的 PaP、D-PaP 或无临床医生预测生存期的 PaP。使用随机效应模型汇总结果，或者在无法进行荟萃分析时以叙述方式总结结果。结果 纳入 39 项研究（n = 10,617 名患者）。PaP 是一种准确的预后工具（汇总 AUC = 0.82，95% CI 0.79-0.84），并且优于没有临床医生预测生存率的 PaP（汇总 AUC = 0.74，95% CI 0.71-0.78），这表明应首选原始 PaP。荟萃分析发现 PaP 和 D-PaP 的性能具有可比性。大多数研究报告了与 PaP 风险组相对应的生存概率，较高风险组与较短的生存期显着相关。结论 PaP 是一种经过验证的癌症患者预后工具，可以增强临床医生预测生存的信心和准确性。未来的研究应该调查准确性是否因临床医生特征而异。必须改进验证研究的报告，因为大多数研究存在很高的偏倚风险，主要是因为没有评估校准。