Prediction of outcome in cancer patients with febrile neutropenia: a prospective validation of the Multinational Association for Supportive Care in Cancer risk index in a Chinese population and comparison with the Talcott model and artificial neural network.
OBJECTIVE
We aimed to validate the Multinational Association for Supportive Care in Cancer (MASCC) risk index, and compare it with the Talcott model and artificial neural network (ANN) in predicting the outcome of febrile neutropenia in a Chinese population.


METHODS
We prospectively enrolled adult cancer patients who developed febrile neutropenia after chemotherapy and risk classified them according to MASCC score and Talcott model. ANN models were constructed and temporally validated in prospectively collected cohorts.


RESULTS
From October 2005 to February 2008, 227 consecutive patients were enrolled. Serious medical complications occurred in 22% of patients and 4% died. The positive predictive value of low risk prediction was 86% (95% CI = 81-90%) for MASCC score ≥ 21, 84% (79-89%) for Talcott model, and 85% (78-93%) for the best ANN model. The sensitivity, specificity, negative predictive value, and misclassification rate were 81%, 60%, 52%, and 24%, respectively, for MASCC score ≥ 21; and 50%, 72%, 33%, and 44%, respectively, for Talcott model; and 84%, 60%, 58%, and 22%, respectively, for ANN model. The area under the receiver-operating characteristic curve was 0.808 (95% CI = 0.717-0.899) for MASCC, 0.573 (0.455-0.691) for Talcott, and 0.737 (0.633-0.841) for ANN model. In the low risk group identified by MASCC score ≥ 21 (70% of all patients), 12.5% developed complications and 1.9% died, compared with 43.3%, and 9.0%, respectively, in the high risk group (p < 0.0001).


CONCLUSIONS
The MASCC risk index is prospectively validated in a Chinese population. It demonstrates a better overall performance than the Talcott model and is equivalent to ANN model.
Hui
Edwin Pun
EP
Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China, huipun@cuhk.edu.hk.
Leung
Linda K S
LK
Poon
Terence C W
TC
Mo
Frankie
F
Chan
Vicky T C
VT
Ma
Ada T W
AT
Poon
Annette
A
Hui
Eugenie K
EK
Mak
So-Shan
SS
Lai
Maria
M
Lei
Kenny I K
KI
Ma
Brigette B Y
BB
Mok
Tony S K
TS
Yeo
Winnie
W
Zee
Benny C Y
BC
Chan
Anthony T C
AT
D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002681:China; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009369:Neoplasms / Q000188:drug therapy; D016571:Neural Networks, Computer; D009503:Neutropenia / Q000139:chemically induced* / Q000208:ethnology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D000970:Antineoplastic Agents
Oncology. 2001;61(4):275-83
11721174
Int J Radiat Oncol Biol Phys. 1998 May 1;41(2):339-45
9607349
Crit Rev Oncol Hematol. 2002 Nov;44(2):163-74
12413633
Support Care Cancer. 2004 Aug;12(8):555-60
15197637
Gastroenterology. 2008 Jan;134(1):65-74
18061180
Lancet. 1995 Oct 21;346(8982):1075-9
7564791
N Engl J Med. 1999 Jul 29;341(5):362-3
10423472
J Antimicrob Chemother. 1999 Mar;43(3):317-20
10223585
Lancet. 1995 Nov 4;346(8984):1175-7
7475653
Radiother Oncol. 2002 Feb;62(2):185-9
11937245
Am J Med. 1995 Mar;98(3):221-3
7872336
J Clin Oncol. 1992 Feb;10(2):316-22
1732432
Clin Infect Dis. 2006 Feb 15;42(4):533-40
16421798
Lancet. 2003 Oct 18;362(9392):1261-6
14575969
Cancer. 2001 Apr 15;91(8 Suppl):1636-42
11309761
Ann Hematol. 2008 Jul;87(7):563-9
18437382
J Clin Oncol. 2008 Feb 1;26(4):606-11
18235119
Blood. 2007 Mar 1;109(5):2066-77
17105821
Arch Intern Med. 1988 Dec;148(12):2561-8
3196123
J Clin Oncol. 2000 Aug;18(16):3038-51
10944139
J Clin Oncol. 2006 Sep 1;24(25):4129-34
16943529
Lancet. 1995 Oct 28;346(8983):1135-8
7475607
Lancet. 1997 Aug 16;350(9076):469-72
9274582
Support Care Cancer. 2008 Jul;16(7):841-6
17960431
Clin Chem. 2003 May;49(5):752-60
12709366
Haematologica. 2006 Feb;91(2):215-22
16461306
Br J Haematol. 1999 Nov;107(2):375-80
10583227
Eur J Cancer Care (Engl). 2007 Nov;16(6):475-83
17944761
Clin Infect Dis. 2001 Jun 15;32(12):1718-25
11360214
Cancer. 2004 Jun 1;100(11):2462-9
15160353
Stat Med. 2000 Feb 29;19(4):541-61
10694735
J Clin Oncol. 1994 Jan;12(1):107-14
8270967