Predicting Survival Time in Noncurative Patients with Advanced Cancer: A Prospective Study in China

Abstract

Background: Accurate prediction of prognosis for cancer patients is important for good clinical decision making in therapeutic and care strategies. The application of prognostic tools and indicators could improve prediction accuracy. Objective: This study aimed to develop a new prognostic scale to predict survival time of advanced cancer patients in China. Methods: We prospectively collected items that we anticipated might influence survival time of advanced cancer patients. Participants were recruited from 12 hospitals in Shanghai, China. We collected data including demographic information, clinical symptoms and signs, and biochemical test results. Log-rank tests, Cox regression, and linear regression were performed to develop a prognostic scale. Results: Three hundred twenty patients with advanced cancer were recruited. Fourteen prognostic factors were included in the prognostic scale: Karnofsky Performance Scale (KPS) score, pain, ascites, hydrothorax, edema, delirium, cachexia, white blood cell (WBC) count, hemoglobin, sodium, total bilirubin, direct bilirubin, aspartate aminotransferase (AST), and alkaline phosphatase (ALP) values. The score was calculated by summing the partial scores, ranging from 0 to 30. When using the cutoff points of 7-day, 30-day, 90-day, and 180-day survival time, the scores were calculated as 12, 10, 8, and 6, respectively. Conclusions: We propose a new prognostic scale including KPS, pain, ascites, hydrothorax, edema, delirium, cachexia, WBC count, hemoglobin, sodium, total bilirubin, direct bilirubin, AST, and ALP values, which may help guide physicians in predicting the likely survival time of cancer patients more accurately. More studies are needed to validate this scale in the future.

A systematically structured review of biomarkers of dying in cancer patients in the last months of life; An exploration of the biology of dying

“…There is Grade A evidence that WBC count is an independent predictor of survival in advanced cancer [31,34,35]. In a UK multicentre cohort study, Gwilliam et al .…”

“…There is Grade B evidence that hyperbilirubinaemia is an independent prognostic factor [26,29,33,35]. Laboratory parameters ALP ( Grade A ), AST ( Grade B ) and ALT ( Grade B ) proved to be prognostically significant in at least one multivariate analysis [24,34,35]. Gwilliam et al .…”

“…also found ALT predictive of two-week, but not two-month survival [34]. There are conflicting results whether GGT is prognostic ( Grade C ) [33,35]. These contrasting results may be explained by the geographical differences in patient groups, the type of patients included and differences in the methods of biochemical analysis of liver function tests.…”

“…There is Grade A evidence that serum sodium is a significant predictor of survival in advanced cancer [30,35]. These studies involved hospitalised patients; and acute illness may be a confounding factor.…”

“…demonstrated serum potassium as a prognostic factor by univariate analysis[35], an additional three articles were identified which failed to demonstrate statistical significance including two multivariate analyses ( Grade D ) [30,33,41]. In one univariate analysis, abnormal plasma glucose levels were predictive of survival ( Grade C ) [35]. …”