Abstract
IntroductionOur aim was to investigate the added prognostic value of a patient-reported functional outcome score over Karnofsky Performance Status (KPS) in patients with non-small-cell lung cancers (NSCLC) with brain metastases.Materials and methodsThe baseline data are from a prospective cohort study involving 140 consecutive patients presenting at our institute. A patient reported performance status (PRPS) was obtained by summing the physical- and role-functioning scale scores of the EORTC QLQ C30 questionnaire. Nested cox proportional hazards models predicting survival were developed including both KPS and PRPS (full model), KPS only (KPS Model), and PRPS only (PRPS model). The incremental value of the addition of KPS or PRPS was ascertained using the likelihood ratio test, model adequacy index and integrated discrimination Improvement (IDI).ResultsPRPS was an independent and statistically significant prognostic factor and had only a moderate degree of agreement with KPS. All models showed nearly the same discrimination and calibration accuracy, but the likelihood ratio test comparing the full model to the KPS model was significant (L.R. Chi2 = 5.34, p = 0.02). Model adequacy index for the KPS model was 85% versus 95% for the PRPS model. IDI when comparing the KPS model to the full model was 0.0279, while it was 0.008 for the PRPS model versus the Full model.ConclusionsUse of patient-reported functional outcomes like PRPS can provide the same prognostic information as KPS in patients of NSCLC with brain metastases.HighlightsPatient-reported functional status (PRPS) has a moderate degree of agreement with KPS.PRPS is an independent and significant predictor of survival in brain metastases.PRPS can replace KPS without loss of prognostic information.
Highlights
Our aim was to investigate the added prognostic value of a patient-reported functional outcome score over Karnofsky Performance Status (KPS) in patients with non-small-cell lung cancers (NSCLC) with brain metastases
The physician-reported performance status is usually reported in the form of a summary score, and the two most commonly used scales are the Karnofsky performance status (KPS) [18], and the Eastern Cooperative Oncology Group Performance Status (ECOG-Performance status (PS)) scales [23]
KPS has been used in successive trials in brain metastases patients and is used for validated prognostic indices like the GPA [33]
Summary
Our aim was to investigate the added prognostic value of a patient-reported functional outcome score over Karnofsky Performance Status (KPS) in patients with non-small-cell lung cancers (NSCLC) with brain metastases. In the context of patients with brain metastases, the baseline PS is the key prognostic factor determining survival [13, 32,33,34]. This is exemplified by the fact that the baseline PS is included in the diagnosis-specific graded prognostic assessment (DS-GPA) score across different primary sites [33]. KPS has been used in successive trials in brain metastases patients and is used for validated prognostic indices like the GPA [33]
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