Comparison of Survival Prognostic Tools in Terminal-stage Tumor Patients: A Multicenter Prospective Cohort Study

Abstract Purpose Previous studies have discussed the effectiveness of the Karnofsky Performance Scale (KPS), Palliative Performance Scale (PPS), Palliative Prognostic Index (PPI), and Delirium-Palliative Prognostic Score (D-PaP) in predicting the survival of patients with terminal-stage tumor, but their effectiveness in the Chinese terminal-stage tumor population still needs to be explored. Therefore, we conducted this prospective cohort study to investigate the applicability of KPS, PPS, PPI, and D-PaP in predicting survival in Chinese patients with terminal-stage tumors. Methods This is a prospective cohort study that collected data from 286 terminal-stage tumor patients across four medical institutions in China from September 2020 to October 2023. The feasibility of using KPS, PPS, PPI, and D-PaP to predict 7-day and 30-day survival in terminal-stage tumor patients was discussed using receiver operating characteristic (ROC) curves. The differences in survival among terminal-stage tumor patients using new cut-off values for the four survival prognostic tools were discussed using Kaplan-Meier survival curves. Results The study ultimately included 286 patients with terminal-stage tumor, with an overall median survival of 8 days. For the prediction of the 30-day survival, the area under the ROC curve of KPS, PPS, PPI, and D-PaP were 0.783 (95% CI 0.687–0.878), 0.756 (0.658–0.855), 0.759 (0.655–0.862), and 0.872 (0.784–0.959), respectively. The optimal cut-off values were 25 for KPS, 35 for PPS, 3.75 for PPI, and 8.25 for D-PaP. Their corresponding sensitivity was 62.2%, 76%, 67.9%, and 88.5%, while their specificity was 83.3%, 70.8%, 75%, and 83.3%, respectively. Conclusion KPS, PPS, PPI, and D-PaP are all effective in predicting survival in Chinese patients with terminal-stage tumors. Particularly, D-PaP is the most suitable for predicting 30-day survival.