Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital (D.D.P., B.S.R.P., C.E.P.), Barretos, Sao Paulo, Brazil; Department of Clinical Oncology, Barretos Cancer Hospital (D.D.P., C.E.P.), Barretos, Sao Paulo, Brazil.
Palliative Care and Quality of Life Research Group, Post-Graduate Program, Barretos Cancer Hospital (D.D.P., B.S.R.P., C.E.P.), Barretos, Sao Paulo, Brazil; Researcher Support Centre, Learning and Research Institute, Barretos Cancer Hospital (B.S.R.P., C.E.P.), Barretos, Sao Paulo, Brazil.
J Pain Symptom Manage. 2022 Jun;63(6):1014-1021.e4. doi: 10.1016/j.jpainsymman.2022.02.004. Epub 2022 Feb 11.
More patients are seeing palliative care (PC) earlier in the disease trajectory. The Barretos Prognostic Nomogram (BPN) was designed to fill the gap of survival prognostication for patients with advanced cancer and months of life expectancy. However, its routine use is limited by the common need for a ruler and calculator. Additionally, the BPN requires blood tests.
The aim is to refine the BPN and to create a prognostic application (App) for use on smartphones.
This is a reanalysis of the two cohorts of advanced cancer patients (development, n=215 and validation, n=276). The variable 'metastasis' was revised (volume-site combinations) and 'KPS' replaced by 'ECOG-PS'. Prognostic variables were selected for multivariable Cox and Log-logistic parametric regression analyses; the most accurate final models were identified by backward variable elimination. Calibration and discrimination properties were evaluated in the validation sample.
The 'full version' model is composed of 6 parameters: sex, locoregional disease, sites of metastasis, ECOG-PS, WBC and albumin. In the 'clinical version' model (5 variables), the variable 'antineoplastic treatment' was included and the laboratory variables were excluded. At validation, both models were well calibrated and presented adequate c-Index values (0.778 and 0.739). HAprog is a freely downloadable offline App that is used by clinicians to calculate prognosis in less than 1 minute.
The new models that integrate HAprog are refined prognostic tools with adequate calibration and discrimination properties. It has potential practical impact for the oncologist dealing with outpatients with advanced cancer during the decision-making process.
越来越多的患者在疾病进程的早期就开始接受姑息治疗（PC）。巴雷托预后诺莫图（BPN）旨在填补晚期癌症和有几个月预期寿命的患者生存预测的空白。然而，其常规使用受到对尺子和计算器的普遍需求的限制。此外，BPN 需要进行血液检查。
目的是改进 BPN，并创建一个可用于智能手机的预后应用程序（App）。
这是对两个晚期癌症患者队列（开发，n=215 和验证，n=276）的重新分析。修订了变量“转移”（体积部位组合），并用“ECOG-PS”代替“KPS”。选择预后变量进行多变量 Cox 和 Log-logistic 参数回归分析；通过向后变量消除确定最准确的最终模型。在验证样本中评估校准和区分性能。
“完整版本”模型由 6 个参数组成：性别、局部区域疾病、转移部位、ECOG-PS、白细胞和白蛋白。在“临床版本”模型（5 个变量）中，包括“抗肿瘤治疗”变量，并排除了实验室变量。在验证中，两个模型都具有良好的校准度和适当的 c-指数值（0.778 和 0.739）。HAprog 是一个免费下载的离线 App，临床医生可以在不到 1 分钟的时间内使用它来计算预后。
新模型集成了 HAprog，是具有良好校准和区分性能的精炼预后工具。它对处理晚期癌症门诊患者的肿瘤学家在决策过程中具有潜在的实际影响。
