Prognostic Indices of Muers et al for a Patient with Non-Small Cell Lung Cancer

Description

Muers et al developed several prognostic indices for evaluating a patient with non-small cell lung cancer. These can help identify a patient who may benefit from more aggressive therapy or novel modality. The authors are from the Yorkshire Cancer Organization in England.

Patient selection: non-small cell carcinoma of the lung

Parameter:

(1) gender

(2) activity score based on WHO (ECOG) performance scale

(3) distant metastases

(4) hoarseness

(5) malaise

(6) physician estimate of survival in months

(7) immediate treatment intent

(8) lymphocyte count

(9) serum albumin

(10) serum sodium

(11) serum alkaline phosphatase

Parameter	Finding	Points
gender	male	0
	female	1
activity score	WHO 0 or 1	0
	WHO 2, 3 or 4	1
distant metastases	absent	0
	probable or definite	1
hoarseness	absent or mild	0
	moderate or severe	1
malaise	absent or mild	0
	moderate or severe	1
immediate treatment intent	supportive care	1
	non-curative radiotherapy	2
	other none-curative care	3
lymphocyte count	>= 1,000 per µL	0
	< 1,000 per µL	1
serum albumin	>= 30 g/L	0
	< 30 g/L	1
serum sodium	>= 135 mmol/L	0
	< 135 mmol/L	1
serum alkaline phosphatase	abnormal	0
	normal	1

prognostic index based on clinical findings =

= (-0.49 * (points for gender)) + (0.35 * (points for activity index)) + (0.52 * (points for distant metastases)) + (0.57 * (points for hoarseness)) + (0.41 * (points for malaise))

prognostic index based on clinical findings plus physician's survival estimate

= (-0.51 * (points for gender)) + (0.17 * (points for activity index)) + (0.35 * (points for distant metastases)) + (0.60 * (points for hoarseness)) + (0.41 * (points for malaise)) - (0.07 * (physician's prediction for survival in months))

prognostic index based on clinical and laboratory findings =

= (-0.42 * (points for distant metastases)) + (1.1 * (points for hoarseness)) + (0.47 * (points for malaise)) - (0.34 * (points for immediate treatment intent)) + (0.72 * (points for lymphocyte count)) + (0.94 * (points for serum albumin)) + (0.62 * (points for serum)) - (0.98 * (points of serum alkaline phosphatase))

Prognostic Index	Score	Prognosis (Median Survival in Months)
clinical findings	<= 0.41	good (9 months)
	0.42 to 0.92	moderate (5 months)
	>= 0.93	poor (1.5 months)
clinical findings plus physician's survival	<= -0.56	good (9 months)
	-0.55 to 0.35	moderate (5 months)
	>= 0.36	poor (1.5 month)
clinical and laboratory	<= -2.85	good (11 months)
	-2.84 to -1.61	moderate (4.5 months)
	>= -1.60	poor (1 month)

The authors also had a prognostic index based on the physician's estimate alone.

prognostic index for physician's estimate =

= (-0.096 * (physician's estimate in months))

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Description

Specialty

ICD-10