Jun Hamano1, Ayano Takeuchi2, Takuhiro Yamaguchi3, Mika Baba4, Kengo Imai5, Masayuki Ikenaga6, Yoshihisa Matsumoto7, Ryuichi Sekine8, Takashi Yamaguchi9, Takeshi Hirohashi10, Tsukasa Tajima11, Ryohei Tatara12, Hiroaki Watanabe13, Hiroyuki Otani14, Hiroka Nagaoka15, Masanori Mori16, Yo Tei17, Shuji Hiramoto18, Tatsuya Morita19. 1. Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan. Electronic address: junhamano@md.tsukuba.ac.jp. 2. Department of Preventive Medicine and Public Health, School of Medicine, Keio University 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan. Electronic address: ayanotakeuchi@keio.jp. 3. Division of Biostatistics, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan. Electronic address: yamaguchi@med.tohoku.ac.jp. 4. Department of Palliative Medicine, Suita Tokushukai Hospital, 21-1 Senriokanishi, Suita, Osaka 565-0814, Japan. Electronic address: mmika@s9.dion.ne.jp. 5. Seirei Hospice, Seirei Mikatahara General Hospital 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka 433-8558, Japan. Electronic address: k.imai@sis.seirei.or.jp. 6. Hospice Children's Hospice Hospital, Yodogawa Christian Hospital 6-9-3, Higashinakagima, Higashiyodogawa-ku, Osaka City, 533-0033, Japan. Electronic address: a190185@ych.or.jp. 7. Department of Palliative Medicine, National Cancer Center Hospital East 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. Electronic address: yosmatsu@east.ncc.go.jp. 8. Department of Pain and Palliative Care, Kameda Medical Center, Higashi-Cho 929, Kamogawa City, Chiba, 296-8602, Japan. Electronic address: sekiner@kameda.jp. 9. Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-1, Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. Electronic address: ikagoro@pop06.odn.ne.jp. 10. Department of Palliative Care, Mitsui Memorial Hospital 1 Kandaizumicho, Chiyoda-ku, Tokyo, 101-8643, Japan. Electronic address: hirohashi.med@gmail.com. 11. Department of Palliative Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8574, Japan. Electronic address: ttajima@med.tohoku.ac.jp. 12. Osaka City General Hospital, Department of Palliative Medicine, 2-13-22 Miyakojima-hondori Miyakojima-ku, Osaka, 534-0021, Japan. Electronic address: r-tatara@hotmail.co.jp. 13. Komaki City Hospital 1-20 Jobushi, Komaki-city, Aichi, 485-8520, Japan. Electronic address: hi.watanabe@komakihp.gr.jp. 14. Department of Palliative Care Team, Palliative and Supportive Care, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan. Electronic address: cas60020@pop21.odn.ne.jp. 15. Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan. Electronic address: nagaoka3taro@gmail.com. 16. Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka, 430-8558, Japan. Electronic address: Masanori.Mori@sis.seirei.or.jp. 17. Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu City, Shizuoka, 433-8558, Japan. Electronic address: y-jeong680909@ktb.biglobe.ne.jp. 18. Department of Oncology, Mitsubishi Kyoto Hospital, Goshocho 1 Katsura Nishikyoku Kyoto, 615-8087, Japan. Electronic address: otomari1rx.8@gmail.com. 19. Department of Palliative and Supportive Care, Palliative Care Team, Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka 433-8558, Japan. Electronic address: tmorita@sis.seirei.or.jp.
Abstract
INTRODUCTION: There have been no reports about predicting survival of patients with advanced cancer constructed entirely with objective variables. We aimed to develop a prognostic model based on laboratory findings and vital signs using a fractional polynomial (FP) model. METHODS: A multicentre prospective cohort study was conducted at 58 specialist palliative care services in Japan from September 2012 to April 2014. Eligible patients were older than 20 years and had advanced cancer. We developed models for predicting 7-day, 14-day, 30-day, 56-day and 90-day survival by using the FP modelling method. RESULTS: Data from 1039 patients were analysed to develop each prognostic model (Objective Prognostic Index for advanced cancer [OPI-AC]). All models included the heart rate, urea and albumin, while some models included the respiratory rate, creatinine, C-reactive protein, lymphocyte count, neutrophil count, total bilirubin, lactate dehydrogenase and platelet/lymphocyte ratio. The area under the curve was 0.77, 0.81, 0.90, 0.90 and 0.92 for the 7-day, 14-day, 30-day, 56-day and 90-day model, respectively. The accuracy of the OPI-AC predicting 30-day, 56-day and 90-day survival was significantly higher than that of the Palliative Prognostic Score or the Prognosis in Palliative Care Study model, which are based on a combination of symptoms and physician estimation. CONCLUSION: We developed highly accurate prognostic indexes for predicting the survival of patients with advanced cancer from objective variables alone, which may be useful for end-of-life management. The FP modelling method could be promising for developing other prognostic models in future research.
INTRODUCTION: There have been no reports about predicting survival of patients with advanced cancer constructed entirely with objective variables. We aimed to develop a prognostic model based on laboratory findings and vital signs using a fractional polynomial (FP) model. METHODS: A multicentre prospective cohort study was conducted at 58 specialist palliative care services in Japan from September 2012 to April 2014. Eligible patients were older than 20 years and had advanced cancer. We developed models for predicting 7-day, 14-day, 30-day, 56-day and 90-day survival by using the FP modelling method. RESULTS: Data from 1039 patients were analysed to develop each prognostic model (Objective Prognostic Index for advanced cancer [OPI-AC]). All models included the heart rate, urea and albumin, while some models included the respiratory rate, creatinine, C-reactive protein, lymphocyte count, neutrophil count, total bilirubin, lactate dehydrogenase and platelet/lymphocyte ratio. The area under the curve was 0.77, 0.81, 0.90, 0.90 and 0.92 for the 7-day, 14-day, 30-day, 56-day and 90-day model, respectively. The accuracy of the OPI-AC predicting 30-day, 56-day and 90-day survival was significantly higher than that of the Palliative Prognostic Score or the Prognosis in Palliative Care Study model, which are based on a combination of symptoms and physician estimation. CONCLUSION: We developed highly accurate prognostic indexes for predicting the survival of patients with advanced cancer from objective variables alone, which may be useful for end-of-life management. The FP modelling method could be promising for developing other prognostic models in future research.
Authors: Patrick Stone; Anastasia Kalpakidou; Chris Todd; Jane Griffiths; Vaughan Keeley; Karen Spencer; Peter Buckle; Dori-Anne Finlay; Victoria Vickerstaff; Rumana Z Omar Journal: Health Technol Assess Date: 2021-05 Impact factor: 4.014