“How Long Have I Got?”—A Prospective Cohort Study Comparing Validated Prognostic Factors for Use in Patients with Advanced Cancer

The oncologist

article

Claribel Simmons¹  Kenneth C. Fearon¹  Marie Fallon¹  Barry J. Laird¹  Donald C. McMillan⁴  Sharon Tuck⁵  Cat Graham⁵  Alistair McKeown¹  Mike Bennett⁶  Claire O'Neill¹  Andrew Wilcock⁷  Caroline Usborne⁸ 

[1] University of Edinburgh, United Kingdom;Deceased.;St Columba's Hospice;Academic Unit of Surgery, University of Glasgow, United Kingdom;Edinburgh Clinical Research Facility, University of Edinburgh, United Kingdom;University of Leeds, United Kingdom;University of Nottingham, United Kingdom;North Wales Cancer Treatment Centre, United Kingdom

关键词: Prognosis;    Inflammation;    Survival;    Cancer;    Palliative;   

DOI  :  10.1634/theoncologist.2018-0474

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background The optimal prognostic factors in patients with advanced cancer are not known, as a comparison of these is lacking. The aim of the present study was to determine the optimal prognostic factors by comparing validated factors. Materials and Methods A multicenter, prospective observational cohort study recruited patients over 18 years with advanced cancer. The following were assessed: clinician-predicted survival (CPS), Eastern Cooperative Oncology Group performance status (ECOG-PS), patient reported outcome measures (anorexia, cognitive impairment, dyspnea, global health), metastatic disease, weight loss, modified Glasgow Prognostic Score (mGPS) based on C-reactive protein and albumin, lactate dehydrogenase (LDH), and white (WCC), neutrophil (NC), and lymphocyte cell counts. Survival at 1 and 3 months was assessed using area under the receiver operating curve and logistic regression analysis. Results Data were available on 478 patients, and the median survival was 4.27 (1.86–7.03) months. On univariate analysis, the following factors predicted death at 1 and 3 months: CPS, ECOG-PS, mGPS, WCC, NC (all p < .001), dyspnea, global health (both p ≤ .001), cognitive impairment, anorexia, LDH (all p < .01), and weight loss ( p < .05). On multivariate analysis ECOG-PS, mGPS, and NC were independent predictors of survival at 1 and 3 months (all p < .01). Conclusion The simple combination of ECOG-PS and mGPS is an important novel prognostic framework which can alert clinicians to patients with good performance status who are at increased risk of having a higher symptom burden and dying at 3 months. From the recent literature it is likely that this framework will also be useful in referral for early palliative care with 6–24 months survival. Implications for Practice This large cohort study examined all validated prognostic factors in a head-to-head comparison and demonstrated the superior prognostic value of the Eastern Cooperative Oncology Group performance status (ECOG-PS)/modified Glasgow Prognostic Score (mGPS) combination over other prognostic factors. This combination is simple, accurate, and also relates to quality of life. It may be useful in identifying patients who may benefit from early referral to palliative care. It is proposed ECOG-PS/mGPS as the new prognostic domain in patients with advanced cancer.

【 授权许可】

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