Comparison of Prognostic Abilities of Palliative Prognostic Index, Laboratory Prognostic Score, and Palliative Prognostic Score.

CONTEXT: Few studies have compared the prognostic value of scoring systems based on physical and blood parameters in terminally ill patients with cancer. OBJECTIVES: This study evaluated the prognostic abilities of Palliative Prognostic Index (PPI), Laboratory Prognostic Score (LPS), and Palliative Prognostic Score (PaP). METHODS: We included 989 terminally ill patients with cancer who consulted for admission to our palliative care unit. We compared the discriminative abilities of PPI, LPS, and PaP for 7-, 14-, 30-, 60-, and 90-day mortality. Additionally, we compared the estimated median survival of PPI, LPS, and PaP with the actual survival (AS). The prediction accuracy was considered adequate if the ratio of estimated median survival in days to AS in days fell within the range of 0.66 to 1.33, optimistic when it exceeds 1.33, and pessimistic when it falls below 0.66. RESULTS: The accuracies for 7-, 14-, 30-, 60-, and 90-day mortality were superior for PPI, LPS, LPS, PaP, and PaP (72%, 73%, 71%, 80%, and 82%), respectively, although the discriminative abilities for 7-, 14-, 30-, 60-, and 90-day mortality were similar among the three scoring systems. The prediction accuracy of survival (PAS) was similar among the three scoring systems with adequate, optimistic, and pessimistic rates of 36%-41%, 20%-46%, and 16%-38%, respectively. PAS was superior in actual survival for 14-59 days. CONCLUSIONS: The prognostic abilities of PPI, LPS, and PaP were comparable. The most adequate estimation occurred for patients with AS for 14-59 days. A more accurate prognostic model is needed for patients with longer survival.

Prognostic laboratory score to predict 14-day mortality in terminally ill patients with respiratory malignancy.

BACKGROUND: Some studies have developed a scoring system to determine the short-term survival of patients with respiratory malignancy. METHODS: A total of 649 terminally ill patients with respiratory malignancy admitted to our palliative care unit were included in this study. They were randomly divided into the investigation (n = 390) and validation (n = 259) groups. Nineteen blood parameters were analyzed in the laboratory. Receiver-operating characteristic analysis was performed for each blood factor and the area under the curve was calculated to determine the predictive value for 14-day survival after the blood test. Multivariable logistic regression analysis was performed to identify the significant independent prognostic factors for 14-day mortality. To develop a scoring system, the laboratory prognostic score for respiratory malignancy (R-LPS) was calculated using the sum of the indices of the independent prognostic factors. RESULTS: Multivariable analysis showed that 8 out of 19 indices, namely, C-reactive protein ≥ 6.8 mg/dL, aspartate aminotransferase ≥ 43 U/L, blood urea nitrogen ≥ 22 mg/dL, white blood cell count ≥ 10.9 × 103/µL, eosinophil percentage ≤ 0.4%, neutrophil-to-lymphocyte ratio ≥ 12.0, red cell distribution width ≥ 16.8, and platelet count ≤ 168 × 103/µL were significant independent factors for 14-day survival in patients with respiratory malignancy. The R-LPS 3 showed acceptable accuracy for 14-day mortality in both the investigation and validation groups and predicted death within 14 days with 75-82% sensitivity and 59-62% specificity. CONCLUSIONS: The R-LPS developed from eight laboratory indices showed acceptable prognostic ability for terminally ill patients with respiratory malignancy.

Development and internal validation of laboratory prognostic score to predict 14-day mortality in terminally ill patients with gastrointestinal malignancy.

BACKGROUND: Few studies have developed an easy scoring system for the short-term survival of patients with gastrointestinal (GI) malignancy. METHODS: A total of 816 terminally ill patients with GI malignancy were admitted to our palliative care unit. They were randomly divided into the investigation (n = 490) and validation (n = 326) groups. A total of 19 laboratory blood parameters were analyzed. Receiver-operating characteristic analysis was performed for each blood factor, and the area under the curve was calculated to determine the predictive value for 14-day survival after the blood test. Multivariable logistic regression analysis was performed to identify significant independent prognostic factors for 14-day mortality. To develop a scoring system for 14-day mortality, the laboratory prognostic score for gastrointestinal malignancy (GI-LPS) was calculated using the sum of indices of the independent prognostic factors. RESULTS: Multivariable analysis showed that 5 of 19 indices, namely total bilirubin ≥ 2.1 mg/dL, blood urea nitrogen ≥ 28 mg/dL, eosinophil percentage ≤ 0.5%, neutrophil-to-lymphocyte ratio ≥ 9.2, and platelet count ≤ 194 × 103/µL, were significant independent factors of 14-day survival. GI-LPS showed acceptable accuracy for 14-day mortality in the investigation and validation groups. GI-LPS 3 (including any three factors) predicted death within 14 days, with a sensitivity of 56-58%, a specificity of 82-87%, a positive predictive value of 48-50%, and a negative predictive value of 87-90%. CONCLUSIONS: GI-LPS showed an acceptable ability to predict 14-day survival and can provide additional information to conventional prognostic scores.

Laboratory prognostic score for predicting 14-day mortality in terminally ill patients with gynecologic malignancy.

BACKGROUND: There are few studies developing a scoring system for short-term survival of patients with gynecologic malignancy. METHODS: Seventy-three terminally ill patients with gynecologic malignancy who were admitted to our palliative care unit (PCU) from June 2009 to February 2018 were included. We accumulated routine blood data within 3 months before PCU discharge. Receiver-operating characteristic analysis was performed on each blood factor, and area under the curve (AUC) was calculated to determine the predictive value for 14-day survival after the blood test. Multivariable logistic regression analysis was performed to identify significant independent prognostic factors of 14-day mortality. To develop a scoring system for 14-day mortality, laboratory prognostic score for gynecologic malignancy (G-LPS) was calculated using the sum of indices of the independent prognostic factors. RESULTS: Multivariable analysis showed that 6 of 24 indices, namely, C-reactive protein ≥ 13.3 mg/dL, total bilirubin ≥ 1.1 mg/dL, sodium < 131 mEq/L, blood urea nitrogen ≥ 28 mg/dL, white blood cell count ≥ 17.7 × 103/µL, and eosinophil level < 0.2%, were significant independent factors of 14-day survival. G-LPS was obtained from the sum of the six indices. The AUC was 0.7977 at the optimal cut-off value of G-LPS 3. G-LPS 3 predicted death within 14 days with a sensitivity of 72% and a specificity of 79%. CONCLUSIONS: Six of the 24 laboratory indices were identified as independent prognostic factors of 14-day mortality in terminally ill patients with gynecologic malignancy. G-LPS showed acceptable ability of predicting 14-day survival.

Laboratory prognostic score for predicting 30-day mortality in terminally ill cancer patients.

Conventional prognostic scores for terminally ill cancer patients may have less objectivity because they include subjective or categorical variables that do not consider intensity or severity. The aim of this study was to identify prognostic factors for 30-day mortality from routine blood examination of terminally ill cancer patients. A total of 1308 study patients in a hospice setting were divided into investigation (n=761) and validation (n=547) groups. Twenty laboratory blood parameters were analyzed. Multivariate analysis revealed that ten variables (C-reactive protein ≥5.4 mg/dL, serum albumin <2.8 g/dL, blood urea nitrogen ≥21 mg/dL, white blood cell count ≥8.600 × 103/µL, eosinophil percentage <0.8%, neutrophil-to-lymphocyte ratio ≥11.1, hemoglobin level ≥ 13.2 g/dL, mean corpuscular volume ≥ 93.7 fl, red cell distribution width ≥ 16, and platelet count < 159 × 103/µL) were significant independent prognostic factors for 30-day survival. The laboratory prognostic score (LPS) was calculated by the sum of blood indices among the ten variables. The LPS showed acceptable accuracy for 30-day mortality in the investigation and validation groups. LPS 5 (including any five factors) predicted death within 30 days, with a sensitivity of 85%, a specificity of 55%, a positive predictive value of 72%, and a negative predictive value of 74%. The predictive value of LPS was comparable to those of conventional prognostic scores, which include signs and symptoms. The LPS can provide additional information to conventional prognostic scores.

[Secondary Dementia Due to Leptomeningeal Metastasis of Breast Cancer Improved by Whole Brain Radiation].

A 62-year-old woman received chemotherapy for breast cancer with bone metastasis and malignant pleural and pericardial effusion. She was examined by imaging for progressive cognitive impairment and headache. Enhanced MRI findings showed multiple solid tumors on brain surface, and brain perfusion scintigraphy showed blood flow decrease in both parietal lobes. She was diagnosed with secondary dementia due to leptomeningeal metastases of breast cancer, and whole brain external irradiation was performed(30 Gy/15 Fr). After treatment, multiple tumors were decreased in size and her cognitive impair- ment was improved.