Abstract
BackgroundThere is an urgent need for a robust, clinically useful predictive model for survival in a heterogeneous group of patients with metastatic cancer referred to radiation oncology.MethodsFrom May 2012 to August 2013, 143 consecutive patients with stage IV cancer were prospectively evaluated by a single radiation oncologist. We retrospectively analyzed the effect of 29 patient, laboratory and tumor-related prognostic factors on overall survival using univariate analysis. Variables that were statistically significant on univariate analysis were entered into a multivariable Cox regression to identify independent predictors of overall survival.ResultsThe median overall survival was 5.5 months. Four prognostic factors significantly predicted survival on multivariable analysis including ECOG performance status (0–1 vs. 2 vs. 3–4), number of active tumors (1 to 5 vs. ≥6), albumin levels (≥3.4 vs. 2.4 to 3.3 vs. <2.4 and primary tumor site (Breast, Kidney or Prostate vs. Other). Risk group stratification was performed by assigning points for adverse prognostic factors resulting in very low, low, intermediate and high risk groups. The median survival was >31.4 months for very low risk patients compared to 14.5 months for low risk, 4.1 months for intermediate risk and 1.2 months for high risk (p<0.001).ConclusionsThese data suggest that a model that considers performance status, extent of disease, primary tumor site and serum albumin represents a simple model to accurately predict survival for patients with stage IV cancer who are potential candidates for radiation therapy.
Highlights
Half of cancer patients referred for radiotherapy evaluation have stage IV cancer [1]
Risk group stratification was performed by assigning points for adverse prognostic factors resulting in very low, low, intermediate and high risk groups
The median survival was >31.4 months for very low risk patients compared to 14.5 months for low risk, 4.1 months for intermediate risk and 1.2 months for high risk (p
Summary
Half of cancer patients referred for radiotherapy evaluation have stage IV cancer [1]. An accurate estimation of life expectancy of patients with metastatic cancer remains a difficult challenge for clinicians [2]. When using intuition and experience alone, clinicians systematically overestimate survival in patients with incurable cancer [3,4]. It is important for clinicians to identify a subset of patients with metastatic cancer that can benefit from improved local control and disease-free survival with aggressive local and systemic therapy [7,8]. There is a clear need for robust models of predicted survival in stage IV cancer. There is an urgent need for a robust, clinically useful predictive model for survival in a heterogeneous group of patients with metastatic cancer referred to radiation oncology
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