Validation of Modified Models of Objective Prognostic Score in Patients With Advanced Cancer
Journal
Journal of palliative medicine
Date Issued
2023-05-17
Author(s)
Yoon, Seok-Joon
Suh, Sang-Yeon
Hiratsuka, Yusuke
Choi, Sung-Eun
Kim, Sun-Hyun
Koh, Su-Jin
Park, Shin Ae
Seo, Ji-Yeon
Kwon, Jung Hye
Park, Jeanno
Park, Youngmin
Hwang, Sun Wook
Lee, Eon Sook
Ahn, Hong-Yup
Chen, Ping-Jen
Yamaguchi, Takashi
Tsuneto, Satoru
Mori, Masanori
Morita, Tatsuya
Abstract
Background: The objective prognostic score (OPS) needs to be modified to reflect practical palliative care circumstances. Objectives: We aimed to validate modified models of OPS with few or no laboratory tests for patients with advanced cancer. Design: An observational study was performed. Setting/Subjects: A secondary analysis of an international, multicenter cohort study of patients in East Asia was performed. The subjects were inpatients with advanced cancer in the palliative care unit. Measurements: We developed two modified OPS (mOPS) models to predict two-week survival: mOPS-A consisted of two symptoms, two objective signs, and three laboratory results, while mOPS-B consisted of three symptoms, two signs, and no laboratory data. We compared the accuracy of the prognostic models using sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Calibration plots for two-week survival and net reclassification indices (NRIs) were compared for the two models. Survival differences between higher and lower score groups of each model were identified by the log-rank test. Results: We included a total of 1796 subjects having median survival of 19.0 days. We found that mOPS-A had higher specificity (0.805-0.836) and higher AUROCs (0.791-0.797). In contrast, mOPS-B showed higher sensitivity (0.721-0.725) and acceptable AUROCs (0.740-0.751) for prediction of two-week survival. Two mOPSs showed good concordance in calibration plots. Considering NRIs, replacing the original OPS with mOPSs improved overall reclassification (absolute NRI: 0.47-4.15%). Higher score groups of mOPS-A and mOPS-B showed poorer survival than those of lower score groups (p < 0.001). Conclusions: mOPSs used reduced laboratory data and had relatively good accuracy for predicting survival in advanced cancer patients receiving palliative care.
Subjects
neoplasms; palliative care; prognostic factors; survival; validity
Type
journal article