NELBI score: a new clinical calculator of thirty-day mortality following systemic anticancer therapy in breast cancer patients near the end of life.

IF 2.9 3区医学 Q1 OBSTETRICS & GYNECOLOGY Breast Cancer Pub Date : 2025-03-01 Epub Date: 2025-01-31 DOI:10.1007/s12282-025-01676-9

Tuğba Önder, Cengiz Karaçin

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Abstract

Aims and objectives: Appropriately timed cessation of systemic anticancer treatments is an important part of a patient's quality of life (QoL). We aimed to determine the right time to discontinue systemic anticancer therapy (SACT) and switch to the best supportive care for patients with advanced breast cancer (BC) who are nearing the end of life.

Methods: We identified 200 BC patients who died within 30 days after palliative SACT. Laboratory parameters and Eastern Cooperative Oncology Group (ECOG) performance status (PS) were recorded when the patients received their last SACT and at the time of their penultimate treatment. The (Neutrophil-ECOG-LDH-Bilirubin) 'NELBI' score, created on the basis of the optimum cut-off points of ECOG PS, neutrophil count, bilirubin level, and lactate dehydrogenase (LDH) level, which can predict mortality within 30 days after SACT, was scored between 0 and 4. Patients were stratified on the basis of the NELBI score.

Results: A total of 4164 patients receiving palliative treatment for advanced BC were examined. A total of 4.8% of patients died within 30 days after SACT. The percentage of patients who died within 30 days after SACT among all deceased patients was 19.4%. The median time from the last systemic treatment to death was 19.5 ± 7.85 (95% CI 18.06-20.26) days, and the median time from the penultimate treatment to death was 43.0 ± 24.65 (95% CI 46.81-53.85) days. A total of 21.3%, 58.0%, 70.7%, and 88.9% of patients with NELBI scores of 0, 1, 2, and 3-4, respectively, died within 30 days after SACT. Compared with a NELBI score of 0, a NELBI score of 1 (OR = 5.095; 95% CI 2.654- 9.784; p < 0.001), a NELBI score of 2 (OR = 8.911; 95% CI 4.299-18.474; p < 0.001), and a NELBI score of 3-4 (OR = 29.500; 95% CI 6.135- 141.847; p < 0.001) was associated with significantly greater 30-day mortality. The AUC of the NELBI scoring for 30-day mortality prediction after SACT was 0.713.

Conclusions: The 'NELBI' scoring system has the potential to significantly improve patient care by guiding the appropriate discontinuation of SACTs in patients with BC.

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NELBI评分：在接近生命末期的乳腺癌患者接受全身抗癌治疗后30天死亡率的一种新的临床计算器。

目的和目的：适时停止全身抗癌治疗是患者生活质量（QoL）的重要组成部分。我们的目的是确定停止全身抗癌治疗（SACT）的正确时间，并转向对接近生命终点的晚期乳腺癌（BC）患者的最佳支持治疗。方法：我们确定了200例姑息性SACT后30天内死亡的BC患者。在患者接受最后一次SACT和第二次治疗时记录实验室参数和东部肿瘤合作组（ECOG）表现状态（PS）。(Neutrophil-ECOG-LDH-Bilirubin)“NELBI”评分是根据ECOG PS、中性粒细胞计数、胆红素水平和乳酸脱氢酶（LDH）水平的最佳截断点创建的，可以预测SACT后30天内的死亡率，评分范围在0到4之间。根据NELBI评分对患者进行分层。结果：共检查了4164例接受姑息治疗的晚期BC患者。共有4.8%的患者在SACT后30天内死亡。SACT术后30天内死亡的患者占所有死亡患者的19.4%。从最后一次全身治疗到死亡的中位时间为19.5±7.85 （95% CI 18.06 ~ 20.26）天，从第二次全身治疗到死亡的中位时间为43.0±24.65 （95% CI 46.81 ~ 53.85）天。分别有21.3%、58.0%、70.7%和88.9%的NELBI评分为0、1、2和3-4的患者在SACT后30天内死亡。与NELBI评分0分相比，NELBI评分1分(OR = 5.095；95% ci 2.654- 9.784；结论：“NELBI”评分系统通过指导BC患者适当停用SACTs，具有显著改善患者护理的潜力。

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来源期刊

Breast Cancer ONCOLOGY-OBSTETRICS & GYNECOLOGY

CiteScore

6.70

自引率

2.50%

发文量

105

审稿时长

6-12 weeks

期刊介绍： Breast Cancer, the official journal of the Japanese Breast Cancer Society, publishes articles that contribute to progress in the field, in basic or translational research and also in clinical research, seeking to develop a new focus and new perspectives for all who are concerned with breast cancer. The journal welcomes all original articles describing clinical and epidemiological studies and laboratory investigations regarding breast cancer and related diseases. The journal will consider five types of articles: editorials, review articles, original articles, case reports, and rapid communications. Although editorials and review articles will principally be solicited by the editors, they can also be submitted for peer review, as in the case of original articles. The journal provides the best of up-to-date information on breast cancer, presenting readers with high-impact, original work focusing on pivotal issues.