Construction of a new, objective prognostic score for terminally ill cancer patients: a multicenter study.
OBJECTIVE
The goal of this study was to develop a new, objective prognostic score (OPS) for terminally ill cancer patients based on an integrated model that includes novel objective prognostic factors.


METHODS
A multicenter study of 209 terminally ill cancer patients from six training hospitals in Korea were prospectively followed until death. The Cox proportional hazard model was used to adjust for the influence of clinical and laboratory variables on survival time. The OPS was calculated from the sum of partial scores obtained from seven significant predictors determined by the final model. The partial score was based on the hazard ratio of each predictor. The accuracy of the OPS was evaluated.


RESULTS
The overall median survival was 26 days. On the multivariate analysis, reduced oral intake, resting dyspnea, low performance status, leukocytosis, elevated bilirubin, elevated creatinine, and elevated lactate dehydrogenase (LDH) were identified as poor prognostic factors. The range of OPS was from 0.0 to 7.0. For the above cutoff point of 3.0, the 3-week prediction sensitivity was 74.7%, the specificity was 76.5%, and the overall accuracy was 75.5%.


CONCLUSIONS
We developed the new OPS, without clinician's survival estimates but including a new prognostic factor (LDH). This new instrument demonstrated accurate prediction of the 3-week survival. The OPS had acceptable accuracy in this study population (training set). Further validation is required on an independent population (testing set).
Suh
Sang-Yeon
SY
Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea.
Choi
Youn Seon
YS
Shim
Jae Yong
JY
Kim
Young Sung
YS
Yeom
Chang Hwan
CH
Kim
Daeyoung
D
Park
Shin Ae
SA
Kim
Sooa
S
Seo
Ji Yeon
JY
Kim
Su Hyun
SH
Kim
Daegyeun
D
Choi
Sung-Eun
SE
Ahn
Hong-Yup
HY
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000855:Anorexia / Q000453:epidemiology; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D003072:Cognition Disorders / Q000453:epidemiology; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D004417:Dyspnea / Q000453:epidemiology; D004435:Eating; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007964:Leukocytosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood* / Q000401:mortality*; D010166:Palliative Care / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D015996:Survival Rate; D013727:Terminal Care / Q000706:statistics & numerical data*
D015415:Biomarkers; D002097:C-Reactive Protein; D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D001663:Bilirubin