Scientific publications

A nomogram for predicting complications in patients with solid tumours and seemingly stable febrile neutropenia

Fonseca PJ (1), Carmona-Bayonas A (2), García IM (3), Marcos R (3), Castañón E (4), Antonio M (5), Font C (6), Biosca M (7), Blasco A (8), Lozano R (3), Ramchandani A (9), Beato C (10), de Castro EM (11), Espinosa J (12), Martínez-García J (13), Ghanem I  (14), Cubero JH (15), Manrique IA (16), Navalón FG (8), Sevillano E (17), Manzano A (18), Virizuela J (19), Garrido M (20), Mondéjar R (21), Arcusa MÁ (22), Bonilla Y (23), Pérez Q (24), Gallardo E (25), Del Carmen Soriano M (26), Cardona M (27), Lasheras FS (28), Cruz JJ (3), Ayala F (2). (1) Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
(2) Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Calle Marqués de los Vélez s/n, Murcia 30008, Spain.
(3) Medical Oncology Department, Hospital Universitario de Salamanca, Salamanca, Spain.
(4) Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain.
(5) Medical Oncology Department, ICO Duran i Reynals, Barcelona, Spain.
(6) Medical Oncology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
(7) Medical Oncology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
(8) Medical Oncology Department, Hospital General Universitario de Valencia, Valencia, Spain.
(9) Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain.
(10) Medical Oncology Department, Hospital NISA Aljarafe, Sevilla, Spain.
(11) Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
(12) Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
(13) Medical Oncology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
(14) Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain.
(15) Medical Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain.
(16) Medical Oncology Department, Hospital Juan Ramón Jiménez, Huelva, Spain.
(17) Medical Oncology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
(18) Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain.
(19) Medical Oncology Department, Hospital Universitario Virgen de Macarena, Sevilla, Spain.
(20) Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile.
(21) Medical Oncology Department, Hospital Universitario de La Princesa, Madrid, Spain.
(22) Medical Oncology Department, Consorci Sanitari de Terrassa, Barcelona, Spain.
(23) Intensive Care Unit, Hospital General Universitario Santa Lucía, Cartagena, Spain.
(24) Medical Oncology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
(25) Medical Oncology Department, Complejo Universitario de Pontevedra, Pontevedra, Spain.
(26) Medical Oncology Department, Hospital Virgen de la Luz de Cuenca, Madrid, Spain.
(27) Internal Medicine Department, Hospital de Tortosa Verge de la Cinta, Tarragona, Spain.
(28) Department of Construction and Manufacturing Engineering, University of Oviedo, Spain.

Magazine: British Journal of Cancer

Date: May 17, 2016

Medical Oncology

BACKGROUND

We sought to develop and externally validate a nomogram and web-based calculator to individually predict the development of serious complications in seemingly stable adult patients with solid tumours and episodes of febrile neutropenia (FN).

PATIENTS AND METHODS

The data from the FINITE study (n=1133) and University of Salamanca Hospital (USH) FN registry (n=296) were used to develop and validate this tool. The main eligibility criterion was the presence of apparent clinical stability, defined as events without acute organ dysfunction, abnormal vital signs, or major infections. Discriminatory ability was measured as the concordance index and stratification into risk groups.

RESULTS

The rate of infection-related complications in the FINITE and USH series was 13.4% and 18.6%, respectively. The nomogram used the following covariates: Eastern Cooperative Group (ECOG) Performance Status ⩾2, chronic obstructive pulmonary disease, chronic cardiovascular disease, mucositis of grade ⩾2 (National Cancer Institute Common Toxicity Criteria), monocytes <200/mm3, and stress-induced hyperglycaemia. The nomogram predictions appeared to be well calibrated in both data sets (Hosmer-Lemeshow test, P>0.1).

The concordance index was 0.855 and 0.831 in each series. Risk group stratification revealed a significant distinction in the proportion of complications. With a ⩾116-point cutoff, the nomogram yielded the following prognostic indices in the USH registry validation series: 66% sensitivity, 83% specificity, 3.88 positive likelihood ratio, 48% positive predictive value, and 91% negative predictive value.

CONCLUSIONS

We have developed and externally validated a nomogram and web calculator to predict serious complications that can potentially impact decision-making in patients with seemingly stable.

CITATION  Br J Cancer. 2016 May 17;114(11):1191-1198. doi: 10.1038/bjc.2016.118

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