Supplementary Material for: Characteristics, Treatment and Prognostic Factors of Patients with Gynaecological Malignancies Treated in a Palliative Care Unit at a University Hospital

<b><i>Background: </i></b>Limited clinical data have been published on patients suffering from advanced gynaecological malignancies treated in palliative care units, and little is known about prognostic factors. <b><i>Methods: </i></b>In a retrospective study, the data of 225 patients with breast, ovarian and cervical cancer treated in the palliative care unit of a university hospital between 1998 and 2009 were assembled. Clinical aspects and baseline symptoms, laboratory parameters, the clinical course, and outcome were evaluated. <b><i>Results: </i></b>225 patients (497 cases; cancer diagnoses: breast 79%, ovarian 13%, and cervix 8%) were included in the analysis. The main symptoms were weakness/fatigue (71%), pain (65%), anorexia/nausea (62%), and dyspnea (46%). Pain control was achieved in 85% of all cases, satisfying control of other symptoms in 80%. The median overall survival (OS) was 59 days. 53% of the patients died at the palliative care unit. In the Cox proportional hazards model, 8 parameters indicated an unfavourable outcome: anorexia/nausea, disordered mental status, elevated lactate dehydrogenase, γ-glutamyltransferase, leukocyte count, hypoalbuminaemia, anaemia and hypercalcaemia. Based on these parameters 3 risk groups were defined: low risk (0-2 factors), intermediate risk (3-5 factors), and high risk (6-8 factors). Median survival for high-risk group was 13 days, for intermediate group 61 days, and for low-risk patients 554 days (p &lt; 0.0001). <b><i>Conclusion: </i></b>Weakness/fatigue, pain and anorexia were the main symptoms leading to the hospitalisation of patients with gynaecological malignancies. Symptom and pain control was accomplished in 80% of cases. 8 parameters were identified as indicating a poor outcome, and patients showing at least 6 or more of these factors had a very limited prognosis. Although studied retrospectively, these results may be helpful for individual treatment decisions in patients with advanced gynaecological malignancies. Prospective data and the introduction of documentation systems could help to gain more powerful knowledge about the quality of palliative care.

**背景**：目前已发表的关于在姑息治疗病房（palliative care unit）接受治疗的晚期妇科恶性肿瘤患者的临床资料十分有限，且其预后影响因素（prognostic factors）的相关研究亦较为匮乏。**方法**：本研究为回顾性研究（retrospective study），纳入了1998年至2009年间，某大学医院姑息治疗病房收治的225例乳腺癌、卵巢癌及宫颈癌患者的临床资料。研究对患者的临床特征、基线症状、实验室检查指标、临床病程及转归进行了评估。**结果**：本分析共纳入225例患者（共计497例次就诊；癌症分型：乳腺癌79%、卵巢癌13%、宫颈癌8%）。患者主要症状为乏力/疲劳（71%）、疼痛（65%）、食欲减退/恶心（62%）及呼吸困难（46%）。85%的病例实现了疼痛控制，80%的病例其他症状得到了满意控制。患者的中位总生存期（overall survival, OS）为59天，53%的患者在姑息治疗病房离世。在考克斯比例风险模型（Cox proportional hazards model）中，共有8项指标提示不良预后：食欲减退/恶心、精神状态紊乱、乳酸脱氢酶（lactate dehydrogenase）升高、γ-谷氨酰转移酶（γ-glutamyltransferase）升高、白细胞计数（leukocyte count）异常、低白蛋白血症（hypoalbuminaemia）、贫血（anaemia）及高钙血症（hypercalcaemia）。基于上述指标，研究将患者划分为3个风险组：低危组（0~2项危险因素）、中危组（3~5项危险因素）及高危组（6~8项危险因素）。高危组患者的中位生存期为13天，中危组为61天，低危组为554天（p < 0.0001）。**结论**：乏力/疲劳、疼痛及食欲减退是妇科恶性肿瘤患者入院接受姑息治疗的主要诱因。80%的病例可实现症状与疼痛的有效控制。本研究共明确8项不良预后相关指标，存在至少6项及以上此类危险因素的患者预后极差。尽管本研究为回顾性研究，但其结果可为晚期妇科恶性肿瘤患者的个体化治疗决策提供参考。未来可通过前瞻性研究及引入标准化医疗记录系统，进一步深化对姑息治疗质量的认知。