title: Evaluation of the Patient-Generated Subjective Global Assessment (PG-SGA) as a predictor of febrile neutropenia in gynecologic cancer patients receiving combination chemotherapy: a pilot study.
abstract: OBJECTIVE
  Determine if pre-treatment Patient-Generated Subjective Global Assessment (PG-SGA) predicts febrile neutropenia (FN) in gynecologic cancer patients receiving primary combination chemotherapy.
  
  
  METHODS
  Following IRB approval, clinicopathologic variables, pre-treatment laboratory values and PG-SGA were recorded from eligible patients. Bone marrow toxicity (CTC 3.0) divided groups of patients: (1) No grade 3 or 4 neutropenia, (2) grade 3 or 4 neutropenia, (3) FN. Statistical analysis with Kruskal-Wallis one-way analysis of variance and a receiver operating characteristic (ROC) curve were performed.
  
  
  RESULTS
  58 patients met study inclusion: 25 in group 1, 28 in group 2, and 5 in group 3. Mean age was 61 and the majority, 42 (72%), had ovarian cancer. Median PG-SGA scores were: 6 (group 1) vs. 7 (group 2) vs. 14 (group 3) (p=0.019). Both median albumin: (1) 4.2 vs. (2) 4.0 vs. (3) 3.4 g/dl (p=0.041), and hemoglobin: (1) 12.1 vs. (2) 11.75 vs. (3) 10.6g/dl (p=0.05) differed between the groups. The overall AUC of the ROC curve for PG-SGA was 0.831 ± 0.064 (95% CI=0.706 to 0.956, p=0.015). Using the ROC, selecting a PG-SGA score of 7.5 to be predictive of febrile neutropenia yields a sensitivity of 100% and a specificity of 60%. When the cutoff value is set at 12.5, the specificity improves to 81% while decreasing sensitivity to 80%.
  
  
  CONCLUSIONS
  PG-SGA scores were higher for patients experiencing FN and may be a reasonably predictive marker of FN in patients receiving multi-agent primary chemotherapy and likely benefactors of prophylactic GCSF.
authors.affiliation: Dept. of OB/GYN, Division of Gynecologic Oncology, Ft. Sam Houston, TX 78234, USA.
authors.forename: Neil T
authors.initials: NT
authors.lastname: Phippen
authors.forename: William J
authors.initials: WJ
authors.lastname: Lowery
authors.forename: J Cory
authors.initials: JC
authors.lastname: Barnett
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Hall
authors.forename: Cristy
authors.initials: C
authors.lastname: Landt
authors.forename: Charles A
authors.initials: CA
authors.lastname: Leath
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000139:chemically induced*; D005833:Genital Neoplasms, Female / Q000188:drug therapy*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D044342:Malnutrition / Q000150:complications; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced*; D015596:Nutrition Assessment; D009752:Nutritional Status; D010865:Pilot Projects; D012372:ROC Curve
chemical_list: D016179:Granulocyte Colony-Stimulating Factor