Prognosis in advanced cancer

Malnutrition is a common reality in many hospitals, especially in cancer patients. In order to avoid its late diagnosis, there are screening instruments that help professionals detect nutritional risk early, thus avoiding further damage to the nutritional status.

To develop a nutritional screening tool for cancer patients undergoing outpatient treatment.

This cross-sectional, observational study was carried out in cancer patients assisted at an outpatient clinic for nutritional care. Data were collected from nutritional care records, including bioelectrical and body composition data (by electrical bioimpedance spectroscopy), anthropometry (adductor pollicis muscle thickness, circumferences, and body mass index), routine clinical biochemical tests, and dynamometry. Malnourished patients were identified through screening using the NRS-2002 method, and all participants were classified according to the GLIM criterion as the control group (no risk and no malnutrition) and the malnourished group. The logistic regression method was used to select the variables that were more sensitive to nutritional risk, thus composing the final screening instrument.

The study sample consisted of 72 patients, 58% male, with a mean age of 63 years (±13.3). The malnourished group had a higher frequency of sarcopenia, worse Karnofsky Performance Status (KPS), and lower values for weight, adductor pollicis muscle thickness (APMT), body mass index (BMI), calf circumference (CC), dynamometry (HAND), and fat mass index (FMI) than the control group. After multivariate analyses and analysis of covariance, the final model was devised in the form of an equation containing two variables, which were more associated with malnutrition, the BMI and the KPS.

The screening instrument developed in this study resulted in an equation for screening nutritional risk, which included the variables KPS and BMI with 84% assertiveness.

Although hepatectomy is a curative treatment modality for hepatocellular carcinoma (HCC), the associated 10-year long-term actual survival are rarely reported. This study aims to develop and validate a predictive nomogram for 10-year actual survivors with HCC.

From 2004 to 2009, 753 patients with curative hepatectomy for HCC (development set, n = 325; validation set, n = 428) were included. In development set, comparison of clinic-pathological data was made between patients surviving ≥10 years and those surviving <10 years. Good independent prognostic factors identified by multivariate analysis were involved in a nomogram development, which was validated internally and externally using validation set.

On multivariate analysis, five independent good prognostic factors for 10-year survival were identified, including young age (OR = 0.943), good ASA status (≤2) (OR = 2.794), higher albumin level (OR = 1.116), solitary tumor (OR = 2.531) and absence of microvascular invasion (OR = 3.367). A novel nomogram was constructed with C-index of 0.801 (95% CI 0.762–0.864). A cut-off point of 167.5 had a sensitivity of 0.794 and specificity of 0.730. Internal validation using bootstrap sampling and external validation using validation set revealed C-index of 0.792 (95% CI, 0.741–0.853) and 0.761 (95% CI, 0.718–0.817).

A novel nomogram for 10-year HCC survivor using age, ASA status, preoperative albumin, tumor number and presence of microvascular tumor invasion was developed and validated with high accuracy.

La atención domiciliaria es una modalidad asistencial cada vez más demandada por los pacientes en situación terminal. Conocer el tiempo de supervivencia permitiría a los equipos asistenciales elaborar planes de cuidados adecuados y afrontar mejor dilemas éticos. No existen suficientes herramientas predictivas de supervivencia en estos pacientes en su atención domiciliaria.

Comprobar la validez y aplicación de una herramienta pronóstica diseñada en medio hospitalario con parámetros biológicos para su aplicación en domicilio.

Estudio analítico, observacional y prospectivo en pacientes oncológicos terminales atendidos por un Equipo de Soporte de Atención Domiciliaria desde 1/10/03 a 7/11/05. A quienes cumplieron criterios de inclusión, previo consentimiento informado, se les extrajo sangre para la determinación de unos parámetros analíticos.

Se analizó el significado pronóstico de las variables obtenidas para supervivencia igual o inferior a 30 días. El modelo predictivo a validar está representado por una ecuación logística. Se analizó su capacidad predictiva calculando la curva ROC y su correspondiente ABC con un IC 95.

Se aplicó en 80 pacientes el modelo y la ecuación pronóstica de Nabal et al., que recoge información relacionada con el síndrome caquexia-anorexia y con la afectación de órganos. Solo leucocitos y neutrófilos presentaron diferencias estadísticamente significativas para supervivencia igual o inferior a 30 días.

El tamaño muestral es pequeño debido a la dificultad de trabajar en domicilio. Los resultados no coinciden con otros modelos, cuestionando la validez de esta herramienta en medio domiciliario. Serían necesarios nuevos trabajos que adapten la metodología desarrollada al ámbito de la atención domiciliaria.

Home care is a health care service that is in increasing demand for terminally ill patients. Knowing survival time would help health care teams to develop appropriate care plans, and to deal with ethical dilemmas. There are not sufficient predictive tools for survival prognosis in those patients.

To verify the validity and application of a prognostic tool designed for a hospital, with analytical parameters for its application in the home setting.

Prospective, observational and analytical study on patients with terminal cancer cared by a home care support team from 10/1/03 to 7/11/05. A blood sample was taken for the analysis of laboratory tests on those patients with, inclusion criteria and prior informed consent. Prognostic significance of the variables obtained for a survival equal to or less than 30 days was analysed. The predictive model to validate was represented by a logistic equation. Its predictive capacity was analysed by calculating the ROC and its corresponding AUC with a 95% confidence interval (CI).

The model and the prognostic equation of Nabal and col. were applied in 80 patients. This collect information associated with cachexia-anorexia syndrome and the organs involved. Only leukocytes and neutrophils showed a statistically significant difference for survival equal to or less than 30 days.

The sample size was small due to the difficulty of working in the home. The results do not agree with other models, questioning the validity of this tool in our environment. More studies that adjust the methodology developed in the field of home care are required.