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Open Access Highly Accessed Research article

Validation of prognostic scores for survival in cancer patients beyond first-line therapy

Olivier Trédan1*, Isabelle Ray-Coquard1, Gisèle Chvetzoff1, Paul Rebattu1, Agathe Bajard2, Sylvie Chabaud2, David Pérol2, Chadi Saba1, Florent Quiblier3, Jean-Yves Blay1 and Thomas Bachelot1

Author Affiliations

1 Université de Lyon, Centre Léon Bérard, Department of Medical Oncology, 28 rue Laennec, 69008 Lyon, France

2 Université de Lyon, Centre Léon Bérard, Department of Statistics, UBET, 28 rue Laennec, 69008 Lyon, France

3 Université de Lyon, Centre Léon Bérard, Department of Clinical Studies, 28 rue Laennec, 69008 Lyon, France

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BMC Cancer 2011, 11:95  doi:10.1186/1471-2407-11-95

Published: 15 March 2011



We aimed to validate prognostic scores for survival in patients undergoing chemotherapy for advanced or metastatic cancer after first-line treatment.


We previously described two models with good prognostic value based on a combination of Performance Status (PS) and either lactate dehydrogenase (LDH) level or lymphocyte count. These factors were evaluated for their ability to predict overall survival (OS) in a prospective cohort of 299 patients. Clinical and blood parameters were prospectively recorded. Candidate prognostic factors for OS with 0.05 significance level in univariate analysis were included in a multivariate Cox model.


Median age was 59 years (range: 26-85). Primary tumor sites were breast (45%), lung (15%), ovaries (11%) and others (29%). The number of metastatic sites was 1 (29%), 2 (48%), >2 (23%). Median follow-up and median OS were 12 and 6 months, respectively. Multiple regression analysis confirmed that PS >1, lymphocyte count ≤700/μL and LDH >600 UI/L were independent predictors of short OS, as well as interleukin 6 (IL-6) level, serum albumin concentration and platelet count.


Prognostic scores using PS plus LDH level or PS plus lymphocyte count were validated for predicting survival in metastatic cancer patients in relapse beyond first-line treatment. A score combining PS, LDH, lymphocyte and platelet count, serum albumin and IL-6 level was superior in determining patients' prognosis.