A prospective comparison of Karnofsky (KPS) with ECOG performance status in patients with non-small cell lung cancer (NSCLC): A COMET group study investigating sensitivity and specificity issues important in clinical decision making

8134 Background: Performance status (PS) continues to be among the most accurate predictors of survival in all patients with lung cancer. Prior studies confirmed that both ECOG and KPS methods are useful and correlate fairly well with each other. However, new findings and practice patterns have necessitated investigation to determine if differences relevant to clinical decision making exist between the two methods. Two key factors have emerged: 1) suitability for chemotherapy is often based on PS (0 - 1 ECOG or 80 - 100 KPS), and 2) recent trials correlating single nucleotide polymorphisms (SNPs) with chemotherapy resistance and survival have found PS to be an important determinant for specific mutations. Methods: 75 patients with advanced NSCLC were prospectively evaluated at 9 COMET sites in Ontario. Both the ECOG and KPS methods, as well as the LCSS-QL (a validated QL instrument) were given prior to receiving initial docetaxel + platinum chemotherapy. Eligibility: PS 0 - 2 ECOG and KPS ≥ 60, Stage III-IV. Descriptive methods and linear regression were used to explore sensitivity and specificity. Results: Median age = 68 (range 46 - 81); men = 55%; median ECOG PS = 1 (11% - 0, 61% - 1, 28% - 2); median KPS = 80 (5% - 100, 28% - 90, 47% - 80, 12% - 70, 8% - 60). Correlation of the two PS methods was fairly high at 0.75 (Pearson r). While this was a positive result, of concern was the finding that the 21 patients with ECOG PS = 2 were as likely to be rated as having a KPS of 60 or 70 or 80, indicating a broad range of activity encompassed by the ECOG 2 category. In contrast, of those with KPS < 80, only 2 patients (3%) had ECOG PS ≤ 1. Sensitivity/specificity results for KPS are 0.86/0.87; for ECOG are 0.96/0.62. Conclusions: Both methods have a high degree of sensitivity; however, the greater specificity of the KPS indicates that it is a better choice 1) for decision making for suitability for chemotherapy (fewer inappropriate patients treated), and 2) for more accurately identifying which patients would benefit from having genomic studies performed to help determine individualized chemotherapy selection. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Aventis Aventis Aventis Aventis Aventis Aventis

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