Abstract
Prediction models are only sparsely available for metastatic oesophagogastric cancer. Because treatment in this setting is often preference-based, decision-making with the aid of a prediction model is wanted. The aim of this study is to construct a prediction model, called SOURCE, for the overall survival in patients with metastatic oesophagogastric cancer. Data from patients with metastatic oesophageal (n = 8010) or gastric (n = 4763) cancer diagnosed during 2005–2015 were retrieved from the nationwide Netherlands cancer registry. A multivariate Cox regression model was created to predict overall survival for various treatments. Predictor selection was performed via the Akaike Information Criterion and a Delphi consensus among experts in palliative oesophagogastric cancer. Validation was performed according to a temporal internal-external scheme. The predictive quality was assessed with the concordance-index (c-index) and calibration. The model c-indices showed consistent discriminative ability during validation: 0.71 for oesophageal cancer and 0.68 for gastric cancer. The calibration showed an average slope of 1.0 and intercept of 0.0 for both tumour locations, indicating a close agreement between predicted and observed survival. With a fair c-index and good calibration, SOURCE provides a solid foundation for further investigation in clinical practice to determine its added value in shared decision making.
Highlights
Patients with oesophageal or gastric cancer have a relatively poor prognosis
The results show that the prediction model has a slightly better performance in oesophageal cancer than in gastric cancer
The SOURCE model presented in this paper is the first prediction model for survival outcome of metastatic oesophageal and gastric cancer patients that was created with a large (n = 12,773)
Summary
Patients with oesophageal or gastric cancer have a relatively poor prognosis. Metastatic disease is reported to be present at diagnosis in around 20–30% of oesophageal and in 30–40% of gastric cancer patients [2,3]. Treatments with curative intent are often not an option when a patient presents with metastatic disease, treatments such as systemic therapy may still prolong life and/or offer symptom relief [4]. That in certain cases best supportive care should be considered in patients with metastatic oesophagogastric cancer [5,6]. As treatment is not always associated with improvement of increased health-related quality of life, the best treatment choice for a particular patient may not be obvious [7]
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