Abstract 1463P
Background
Prognostic tools have been used in clinical practice helping to estimate survival in advanced cancer patients. The Barretos Prognostic Nomogram (BPN) is an instrument composed of 5 variables: sex, metastasis, leukocytes, KPS and albumin. Although accurate, it has some limitations such as the variable ‘metastasis’ as dichotomous and KPS as functionality evaluation, less used in the oncologist's clinical routine. We aimed at improving the BPN by reclassifying the variable ‘metastasis’ and assessing functional performance by ECOG-PS (BPN v2.0 model) and developing an alternative version without laboratorial varibles (BPN vClin model).
Methods
This was a reanalysis of the data from the BPN's 497 advanced cancer patients when referred to Palliative Care (development sample n=221; validation sample n=276). Site-volume combinations were tested for the ‘metastasis’ variable and KPS was replaced by ECOG-PS to assess functional performance. Prognostic variables were selected for multivariable Cox regression analyses; the most accurate final models were identified by backward variable elimination. Calibration and discrimination properties of the new models for BPN were evaluated in the validation sample.
Results
BPN v2.0 model was composed of 6 parameters: sex, locoregional disease present, metastasis sites (liver; bone; CNS; peritoneum; adrenal and/or spleen and/or kidney; muscle and/or subcutaneous), ECOG-PS, white blood cell (WBC), and albumin. The C-index was 0.78. The values of the area under the curve (AUC) of the receiver operating characteristic (ROC) curve were 0.79, 0.74, and 0.73 at 30, 90, and 180 days, respectively. The BPN vClin model was composed of 5 parameters: as compared with the v2.0 model there was the inclusion of ‘antineoplastic treatment’ and exclusion of laboratorial variables. The C-index was 0.74. The values of the AUC of the ROC curve were 0.77, 0.74, and 0.71 at 30, 90, and 180 days, respectively. Both versions presented good calibration results according to the Hosmer-Lemeshow test.
Conclusions
The new models are refined prognostic tools with adequate calibration and discrimination properties. It could be used to assist health professionals in estimating the survival of advanced cancer outpatients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Barretos Cancer Hospital.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.