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Prognostic factors in patients with recently diagnosed incurable cancer: a systematic review

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Abstract

Goals of work

To review the literature and develop a conceptual framework about prognostic factors for people presenting to medical oncologists with recently diagnosed incurable cancer.

Materials and methods

Medline was searched from January 2000 to October 2003 to identify articles testing associations between clinical or laboratory variables and survival time in adults with advanced solid tumours and median survival of 3 to 24 months. We recorded how frequently prognostic factors were significantly associated with survival in univariable and multivariable analyses.

Results

There were 53 studies included. The factors associated with survival were organised into four categories related to attributes of the host the tumour, the treatment and the interactions between host, tumour and treatment (symptoms, quality of life, performance status and laboratory tests). Co-morbidity was consistently associated with shorter survival. Age and gender were not consistently associated with survival duration, except in lung cancer where females survived longer. Tumour-related factors associated with shorter survival included primary tumour (lung), metastatic site (liver, brain and visceral) and disease extent. Symptoms associated with shorter survival included those of the anorexia–cachexia syndrome, dyspnoea, pain and impaired physical well being. Performance status was strongly associated with survival in most studies. Laboratory tests associated with shorter survival included anaemia, thrombocytopenia, hypoalbuminaemia and elevated serum levels of both alkaline phosphatase and lactate dehydrogenase.

Conclusion

Prognostic factors in patients with advanced cancer can be conceptualised as attributes of the host, tumour, treatment and interactions between the three reflected in symptoms, quality of life performance status and laboratory tests.

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Authors and Affiliations

  1. Sydney Cancer Centre, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia

    Catherine A. Hauser, Martin R. Stockler & Martin H. N. Tattersall

  2. Department of Cancer Medicine, Blackburn Building DO6, University of Sydney, Sydney, NSW, 2006, Australia

    Martin R. Stockler & Martin H. N. Tattersall

  3. NH&MRC Clinical Trials Centre, Locked Bag 77, Camperdown, NSW, 1450, Australia

    Martin R. Stockler

Authors
  1. Catherine A. Hauser
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  2. Martin R. Stockler
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  3. Martin H. N. Tattersall
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Corresponding author

Correspondence to Martin H. N. Tattersall.

Additional information

Research was supported by Derham Green Fund Research Grant.

The authors have no conflicts of interest to declare.

Appendix

Appendix

Appendix I. Excluded studies

1. Walsh D, Rybicki L, Nelson KA, Donnelly S (2002) Symptoms and prognosis in advanced cancer. Support Care Cancer 10(5):385–388

2. Ruka W, Rutkowski P, Kaminska J, Rysinska A, Steffen J (2001) Alterations of routine blood tests in adult patients with soft tissue sarcomas: relationships to cytokine serum levels and prognostic significance. Ann Oncol 12(10):1423–1432

3. Nakamachi H, Suzuki H, Akakura K, Imamoto T, Ueda T, Ishihara M et al (2002) Clinical significance of pulmonary metastases in stage D2 prostate cancer patients. Prostate Cancer Prostatic Dis 5(2):159–163

4. Andreopoulou E, Andreopoulos D, Adamidis K, Fountzila-Kalogera A, Fountzilas G, Dimopoulos MA et al (2002) Tumor volumetry as predictive and prognostic factor in the management of ovarian cancer. Anticancer Res 22(3):1903–1908

5. Walsh D, Mahmoud F, Barna B (2003) Assessment of nutritional status and prognosis in advanced cancer: interleukin-6, C-reactive protein, and the prognostic and inflammatory nutritional index. Support Care Cancer 11(1):60–62

6. Geissbuhler P, Mermillod B, Rapin CH (2000) Elevated serum vitamin B12 levels associated with CRP as a predictive factor of mortality in palliative care cancer patients: a prospective study over five years. J Pain Symptom Manage 20(2):93–103

7. Chan JK, Loizzi V, Burger RA, Rutgers J, Monk BJ (2003) Prognostic factors in neuroendocrine small cell cervical carcinoma: a multivariate analysis. Cancer 97(3):568–574

8. Chi DS, Liao JB, Leon LF, Venkatraman ES, Hensley ML, Bhaskaran D et al (2001) Identification of prognostic factors in advanced epithelial ovarian carcinoma. Gynecol Oncol 82(3):532–537

9. Pasanisi F, Orban A, Scalfi L, Alfonsi L, Santarpia L, Zurlo E et al (2001) Predictors of survival in terminal-cancer patients with irreversible bowel obstruction receiving home parenteral nutrition. Nutrition 17(7–8):581–584

Appendix II. Included studies

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Hauser, C.A., Stockler, M.R. & Tattersall, M.H.N. Prognostic factors in patients with recently diagnosed incurable cancer: a systematic review. Support Care Cancer 14, 999–1011 (2006). https://doi.org/10.1007/s00520-006-0079-9

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