Background The geriatric oncology population tends to be complex because of multimorbidity, functional and cognitive decline, malnutrition and social frailty. Prognostic indices for predicting survival of elderly cancer patients to guide treatment remain scarce. A nomogram based on all domains of the geriatric assessment was previously developed at the National Cancer Centre Singapore (NCCS) to predict overall survival (OS) in elderly cancer patients. This nomogram comprised of six variables (age, eastern cooperative oncology group performance status, disease stage, geriatric depression scale (GDS), DETERMINE nutritional index and serum albumin). Objectives To externally validate the NCCS prognostic nomogram. Design This is a prospective cohort study. Methods The nomogram was developed based on a training cohort of 249 patients aged ⩾70 years who attended the NCCS outpatient geriatric oncology clinic between May 2007 and November 2010. External validation of the nomogram using the Royston and Altman approach was carried out on an independent testing cohort of 252 patients from the same clinic between July 2015 and June 2017. Model misspecification, discrimination and calibration were assessed. Results Median OS of the testing cohort was 3.1 years, which was significantly higher than the corresponding 1.0 year for the training cohort (log-rank p < 0.001). The nomogram achieved a high level of discrimination in the testing cohort (0.7112), comparable to the training cohort (0.7108). Predicted death probabilities were generally well calibrated with the observed death probabilities, as the joint test of calibration-in-the-large estimates at year 1, 2 and 3 from zeros and calibration slope from one was insignificant with p = 0.432. There were model misspecifications in GDS and serum albumin. Conclusion This study externally validated the prognostic nomogram in an independent cohort of geriatric oncology patients. This supports the use of this nomogram in clinical practice.

中文翻译：

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对患有癌症的老年人的第一个预后列线图进行外部验证。

背景 由于多发病、功能和认知能力下降、营养不良和社会脆弱，老年肿瘤人群往往很复杂。用于预测老年癌症患者生存以指导治疗的预后指标仍然很少。新加坡国家癌症中心 (NCCS) 此前开发了基于老年评估所有领域的列线图，用于预测老年癌症患者的总生存期 (OS)。该列线图由六个变量组成（年龄、东部肿瘤合作组表现状态、疾病阶段、老年抑郁量表（GDS）、确定营养指数和血清白蛋白）。目标 从外部验证 NCCS 预后列线图。设计 这是一项前瞻性队列研究。方法 列线图是根据 2007 年 5 月至 2010 年 11 月期间在 NCCS 老年肿瘤门诊就诊的 249 名 70 岁以上患者的训练队列制定的。使用 Royston 和 Altman 方法对列线图进行了外部验证，并进行了独立测试2015 年 7 月至 2017 年 6 月期间来自同一诊所的 252 名患者组成的队列。对模型的错误指定、歧视和校准进行了评估。结果 测试队列的中位 OS 为 3.1 年，显着高于训练队列相应的 1.0 年（对数秩 p < 0.001）。列线图在测试队列中实现了高水平的区分度 (0.7112)，与训练队列 (0.7108) 相当。预测的死亡概率通常与观察到的死亡概率进行了很好的校准，因为第 1 年、第 2 年和第 3 年从零开始的大规模估计校准和从 1 开始的校准斜率的联合测试不显着，p = 0.432。GDS 和血清白蛋白的模型存在错误。结论 本研究从外部验证了老年肿瘤患者独立队列的预后列线图。这支持了该列线图在临床实践中的使用。