Predicting other-cause mortality: The minimalistic approach

摘要

For the better part of the history of medicine, physicians have relied on clinical judgment to estimate a patient's odds of benefiting from an intervention. On the one hand, there is little doubt that a healthy 50-yr-old man should be treated for locally advanced prostate cancer (PCa) or that an 89-yr-old man would best be kept on watchful waiting for very-low-risk PCa. On the other hand, for anything in between these outliers, clinicians rely on their intuition, which essentially amounts to a quasisubjective assessment and understanding of life expectancy weighted against the severity of comorbidities. Clinical judgment will vary between individual providers (interobserver variation) and may also vary within the same provider (intraobserver variation), depending on arbitrary criteria such as the time of the day and the cultural context. Such observations are troublesome, as patients deserve a more systematic and objective evaluation of their likelihood to benefit from a given treatment.