Clinical prognostic scoring system to aid decision-making in gastro-oesophageal cancer.
BACKGROUND
Accurate prediction of prognosis in gastro-oesophageal cancer remains challenging. The aim of this study was to develop a robust model for outcome prediction.


METHODS
The study included 220 patients with gastric or oesophageal cancer newly diagnosed over a 2-year period. Patients were staged and underwent treatment following discussion at a multidisciplinary team (MDT) meeting. Clinical and investigative variables were collected, including performance and nutritional status, and serum C-reactive protein (CRP) level. Primary endpoints were death within 12 and 24 months.


RESULTS
Overall median survival was 13 months. Advanced clinical stage (P < 0.001), reduced performance score (P < 0.001), weight loss exceeding 2.75 per cent per month (P = 0.026) and serum CRP concentration above 5 mg/l (P = 0.031) were identified as independent prognostic indicators in multivariable analysis. A prognostic score was constructed using these four variables to estimate a probability of death. Applying the model gave an area under the receiver-operator characteristic curve of 0.84 and 0.85 for prediction of death at 12 and 24 months respectively (both P < 0.001).


CONCLUSIONS
This model accurately estimated the probability of death within 12 and 24 months. This may aid the MDT decision-making process.
Deans
D A C
DA
University Department of Surgery, Royal Infirmary, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK. cdeans@doctors.org.uk
Wigmore
S J
SJ
de Beaux
A C
AC
Paterson-Brown
S
S
Garden
O J
OJ
Fearon
K C H
KC
D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D003657:Decision Making; D003661:Decision Support Techniques; D004938:Esophageal Neoplasms / Q000097:blood / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000097:blood / Q000401:mortality*; D015431:Weight Loss
D002097:C-Reactive Protein