Abstract 65P
Background
Validated prognostic indexes are essential for BTC. We previously set up the PECS index (PsECogSii), made of PS ECOG and Systemic Inflammatory Index. To improve its power, we created the PECS2 index made of PECS, Prognostic Nutritional Index (PNI) and GOT. We aim to evaluate PECS2 index as prognostic factor in unresectable locally advanced or metastatic BTC patients treated with first-line chemotherapy.
Methods
The study was retrospectively conducted on a training cohort of 126 BTC patients from Modena Cancer Center. A first validation cohort of 457 patients was recruited by 13 Italian Cancer Centers, a second one of 76 patients by University of Cagliari and Istituto Nazionale dei Tumori of Milan and a third one of 256 patients by ASAN medical Center in Republic of Korea. The PECS2 index was calculated as PECS+PNI+GOT (PECS:0=1 point; PECS:1=1.4 points; PECS:2=3.2 points) + (PNI>36.7=1 point; PNI<36.7=2 points) + (GOT<100=1 point; GOT>100=2 points). Patients were categorized into 3 groups: PECS2-0 (value<3.5 points), PECS2-1 (value>3.5 points;<5.4 points), PECS2-2 (value>5.4 points).
Results
In the training cohort, median overall survival (mOS) was 12.9,6.3 and 2.8 months for PECS2-0, PECS2-1 and PECS2-2, respectively (PECS2-0:HR 1; PECS2-1:HR 2.11; PECS2-2:HR 4.93; p<0.0001). The Harrell’s C between PECS and PECS2 increased from 0.69 to 0.78 (95%CI:0.68–0.87; p=0.001). In the first validation cohort, mOS was 11.5,7.3 and 3.3 months for PECS2-0, PECS2-1 and PECS2-2, respectively (PECS2-0:HR 1; PECS2-1:HR 1.74; PECS2-2:HR 3.41; p<0.0001). In the second validation cohort, mOS was 25.2,12.5 and 3.0 months for PECS2-0, PECS2-1 and PECS2-2, respectively (PECS2-0:HR 1; PECS2-1:HR 2.33; PECS2-2:HR 8.46; p<0.0001). In the third validation cohort, mOS was 11.8,8.1 and 4.6 months for PECS2-0, PECS2-1 and PECS2-2, respectively (PECS2-0:HR 1; PECS2-1:HR 1.47; PECS2-2:HR 3.17; p<0.0001). Multivariate analysis in all cohorts confirmed the PECS2 index as an independent prognostic factor for OS.
Conclusions
The low cost, easy assessment, reproducibility and good risk-stratification performance make PECS2 index a promising tool to assess BTC patients’ prognosis in future clinical practice.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.