Development and Validation of a Prognostic Nomogram for Terminally Ill Cancer Patients
| Autor: | Jaime Feliu, Ana María Jimenez-Gordo, Juan Carlos Cámara, Javier de Castro, Alberto Alonso-Babarro, Rosario Madero, José Ramón Rodríguez-Aizcorbe, Enrique Espinosa, Beatriz Martínez, Raquel Molina, Manuel González-Barón, Jesús Domingo Acedo, María Luisa García-Paredes |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Research design Oncology Cancer Research medicine.medical_specialty Time Factors Palliative care Multivariate analysis Adolescent Kaplan-Meier Estimate Risk Assessment Life Expectancy Predictive Value of Tests Risk Factors Neoplasms Internal medicine Activities of Daily Living Weight Loss medicine Humans Terminally Ill Lymphocyte Count Intensive care medicine Aged Neoplasm Staging Proportional Hazards Models Aged 80 and over Proportional hazards model business.industry Palliative Care Reproducibility of Results Middle Aged Nomogram Prognosis Nomograms Research Design Spain Predictive value of tests Multivariate Analysis Cohort Disease Progression Female Cognition Disorders Risk assessment business Biomarkers |
| Zdroj: | JNCI: Journal of the National Cancer Institute. 103:1613-1620 |
| ISSN: | 1460-2105 0027-8874 |
| Popis: | Background Determining life expectancy in terminally ill cancer patients is a difficult task. We aimed to develop and validate a nomogram to predict the length of survival in patients with terminal disease. Methods From February 1, 2003, to December 31, 2005, 406 consecutive terminally ill patients were entered into the study. We analyzed 38 features prognostic of life expectancy among terminally ill patients by multivariable Cox regression and identified the most accurate and parsimonious model by backward variable elimination according to the Akaike information criterion. Five clinical and laboratory variables were built into a nomogram to estimate the probability of patient survival at 15, 30, and 60 days. We validated and calibrated the nomogram with an external validation cohort of 474 patients who were treated from June 1, 2006, through December 31, 2007. Results The median overall survival was 29.1 days for the training set and 18.3 days for the validation set. Eastern Cooperative Oncology Group performance status, lactate dehydrogenase levels, lymphocyte levels, albumin levels, and time from initial diagnosis to diagnosis of terminal disease were retained in the multivariable Cox proportional hazards model as independent prognostic factors of survival and formed the basis of the nomogram. The nomogram had high predictive performance, with a bootstrapped corrected concordance index of 0.70, and it showed good calibration. External independent validation revealed 68% predictive accuracy. Conclusions We developed a highly accurate tool that uses basic clinical and analytical information to predict the probability of survival at 15, 30, and 60 days in terminally ill cancer patients. This tool can help physicians making decisions on clinical care at the end of life. |
| Databáze: | OpenAIRE |
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