Individual life expectancy estimation using validated prognostic scores for patients with cancer of unknown primary.
OBJECTIVE
To implement 3 published prognostic scores in an independent set of patients with cancer of unknown primary (CUP), and compare their performance on individual life expectancy prediction.


METHODS
The survival of 430 consecutive patients with CUP was measured after they had allocated to their prognostic group (good prognosis vs. poor prognosis) according to each prognostic score. Using a 2 x 2 contingency table, we measured the sensitivity, specificity, positive predictive value (PPV) and accuracy of each score in predicting individual outcome (survival <90 days or >180 days).


RESULTS
The median overall survival was 189 days (1-4,801 days). Survival was <90 days in 143/421 cases and >180 days in 208/413 cases. The three PPVs were within the same range for prediction of survival <90 days (from 43 to 49%) as well as for prediction of survival >180 days (from 70 to 80%), and underestimate individual life expectancy of 40-50% of the patients. None of the 3 scores appeared significantly better.


CONCLUSIONS
The main finding of this retrospective analysis is that the published prognostic scores cannot be used for rational decision making.
Ferté
Charles
C
Département de Cancérologie Générale, Centre de Lutte Contre le Cancer Oscar Lambret, Lille, France.
Penel
Nicolas
N
Bonneterre
Jacques
J
Adenis
Antoine
A
D000368:Aged; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary; D003657:Decision Making; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009382:Neoplasms, Unknown Primary / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome