일개 상급종병원 완화의료 병동 말기 암환자를 대상으로 Objective Prognostic Score의 타당도 조사

Abstract

Background: OPS (Objective Prognostic Score) have been developed to predict the 3-week survival of terminally ill cancer patients from six training hospitals in Korea based on an integrated model using symptoms, performance status, and routine blood tests for inpatients in 2007. The purpose of this study is to validate OPS for terminally ill cancer patients in a tertiary hospital of Korea. Methods: 163 terminally ill cancer patients hospitalized at hospice palliative care unit of a university hospital in Korea from January 2012 to December 2013 were retrospectively analyzed. The OPS was calculated from the sum of partial scores obtained from following seven significant predictors: anorexia, dyspnea, the Eastern Cooperative Oncology Group (ECOG) performance status scale, white blood cell (WBC) count, total bilirubin, creatinine and lactate dehydrogenase (LDH). The accuracy of the OPS was evaluated. Results: The median survival was 15 days (95% confidence interval 12∼18 days). The predictors that validated significant by the multivariate analysis were low performance status (HR=1.62; P=0.0295), leukocytosis (HR=1.46; P=0.0265), elevated serum bilirubin (HR=1.57; P=0.0164), elevated serum creatinine (HR=1.71; P=0.0258), and elevated serum LDH (HR=1.49; P=0.0320). The cutoff point for the prediction of survival time shorter than 3 weeks was set at 3.0 (sensitivity 82.1%, specificity 52.6%). Conclusion: OPS has been validated in this population and was useful to predict the 3-week survival of terminally ill cancer patients in a tertiary hospital of Korea. It may help in making decisions about hospice care for patients and their families.