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Abstract
Objectives To develop and validate a new prognostic model to predict 90-day mortality in patients with incurable cancer.
Methods In this prospective cohort study, patients with incurable cancer receiving palliative care (n = 1322) were randomly divided into two groups: development (n = 926, 70%) and validation (n = 396, 30%). A decision tree algorithm was used to develop a prognostic model with clinical variables. The accuracy and applicability of the proposed model were assessed by the C-statistic, calibration and receiver operating characteristic (ROC) curve.
Results Albumin (75.2%), C reactive protein (CRP) (47.7%) and Karnofsky Performance Status (KPS) ≥50% (26.5%) were the variables that most contributed to the classification power of the prognostic model, named Simple decision Tree algorithm for predicting mortality in patients with Incurable Cancer (acromion STIC). This was used to identify three groups of increasing risk of 90-day mortality: STIC-1 - low risk (probability of death: 0.30): albumin ≥3.6 g/dL, CRP <7.8 mg/dL and KPS ≥50%; STIC-2 - medium risk (probability of death: 0.66 to 0.69): albumin ≥3.6 g/dL, CRP <7.8 mg/dL and KPS <50%, or albumin ≥3.6 g/dL and CRP ≥7.8 mg/dL; STIC-3 - high risk (probability of death: 0.79): albumin <3.6 g/dL. In the validation dataset, good accuracy (C-statistic ≥0.71), Hosmer-Lemeshow p=0.12 and area under the ROC curve=0.707 were found.
Conclusions STIC is a valid, practical tool for stratifying patients with incurable cancer into three risk groups for 90-day mortality.
- prognosis
- clinical decisions
- cancer
- terminal care
Data availability statement
No data are available. Not applicable.
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Data availability statement
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Footnotes
Contributors RdS-S: project conception; development of the overall research plan; analysis and interpretation of data; drafting of the article. LCdO: project conception; development of the overall research plan; analysis and interpretation of data; drafting of the article; guarantor. EVMW, LC-L: project conception, development of the overall research plan; interpretation and editing; critical revision of important intellectual content. All the authors read and approved the final version submitted.
Funding The author(s) disclose receipt of the following financial support for the research, authorship and/or publication of this article: grant number E-26/202.547/2022 from the Rio de Janeiro state research funding agency Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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