Karnofsky and ECOG performance status scoring in lung cancer: A prospective, longitudinal study of 536 patients from a single institution

doi:10.1016/0959-8049(95)00664-8

European Journal of Cancer

Volume 32, Issue 7, June 1996, Pages 1135-1141

https://doi.org/10.1016/0959-8049(95)00664-8 Get rights and content

Abstract

The Karnofsky's index of performance status (KPS) and the Eastern Cooperative Oncology Group Performance Status Scale (ECOG PS) are widely used methods of assessing the functional status of cancer patients. In this study, we compare their predictive validity, and suggest a table of transformation between scales. 536 consecutive lung cancer patients were assigned both KPS and ECOG PS scores before, during and after treatment (in all, 1656 assignments). Patients were accurately staged at diagnosis, and carefully re-evaluated at each follow-up visit. Multiple clinical, laboratory and instrumental data were recorded along with performance status assessments. Survival times were measured from the pathological diagnosis. KPS and ECOG PS assignments were strongly related to each other (Spearman R = − 0.869). Correlation between scales persisted unchanged in pretreatment and post-treatment assessments, advanced and limited diseases, response or non-response to treatment, and different assessors (R indices ranging from −0.825 to −0.901). A three-point conversion table showed the highest rate of success with an overall percentage of agreement exceeding 84% (grade 1: KPS = 100, 90, 80 and ECOG PS = 0, 1; grade 2: KPS = 70, 60 and ECOG PS = 2; grade 3: KPS < 60 and ECOG PS = 3, 4). Both univariate and multivariate analyses of survival documented the predictive validity of the two scales. However, KPS showed less ability than ECOG PS to discriminate patients with different prognosis. Because of the better predictive ability shown in this study, ECOG PS should be preferred to KPS. A general consensus on the scale to use could avoid problems of conversion, which is not always easy and free of errors.

References (28)

CG Zubrod et al.
Appraisal of methods for the study of chemotherapy in man: comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide
J Chron Dis
(1960)
E Verger et al.
Can Karnofsky performance status be transformed to the Eastern Cooperative Oncology Group Scoring Scale and vice versa?
Eur J Cancer
(1992)
G Buccheri et al.
Anti-CEA immunoscintigraphy might be more useful than computed tomography in the preoperative thoracic evaluation of lung cancer
Chest
(1993)
G Buccheri et al.
A randomised trial of MACC chemotherapy with or without lonidamine in advanced non-small cell lung cancer
Eur J Cancer
(1994)
JD Minna et al.
Cancer of the lung
ST Orr et al.
Performance status assessment among oncology patients: a review
Cancer Treat Rep
(1986)
D Tummarello et al.
Symptomatic, stage IV, non-small-cell lung cancer (NSCLC): response, toxicity, performance status change and symptom relief in patients treated with cisplatin, vinblastine and mitomycin-C
Cancer Chemother Pharmacol
(1995)
PA Ganz et al.
Quality of life assessment. An independent prognostic variable for survival in lung cancer
Cancer
(1991)
S Capewell et al.
Performance and prognosis in patients with lung cancer
Thorax
(1990)
G Buccheri et al.
Prognostic factors in lung cancer: tables and comments
Eur Resp J
(1994)

DA Karnofsky et al.

The clinical evaluation of chemotherapeutic agents in cancer

V Mor et al.

The Karnofsky performance status scale. An examination of its reliability and validity in a research setting

Cancer

(1984)

C Coscarelli Schag et al.

Karnofsky performance status revised: reliability, validity, and guidelines

J Clin Oncol

(1984)

C Conill et al.

Performance status assessment in cancer patients

Cancer

(1990)

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L’indice de performance ou « Performance Status (PS) » est une mesure de l’état général du patient. Les échelles de Karnofsky et de l’ECOG (Eastern Cooperative Oncology Group) sont les plus utilisées. La meilleure corrélation est obtenue en utilisant 3 points : ECOG 0-1 = Karnofsky 100-80 %, ECOG 2 = Karnofsky 60-70 %, ECOG 3-4 = Karnofsky 50-10 %. De nombreux facteurs, liés au cancer ou aux comorbidités peuvent influencer le PS. Malgré une évaluation dont la reproductibilité n’est pas parfaite et le caractère hétérogène des patients au PS altéré, le PS est un facteur pronostique indépendant majeur des CBNPC (cancers bronchiques non à petites cellules) et des CPC (cancers à petites cellules). Il doit donc être un facteur de stratification dans les études. Toutes les recommandations tiennent compte du PS dans la décision thérapeutique, en particulier pour la chimiothérapie des CBNPC métastatiques. Les thérapies ciblées, en cas de tumeur métastatique avec altération moléculaire ciblable, doivent être proposées quel que soit le PS du fait d’un profil efficacité/tolérance très favorable. Les données concernant l’immunothérapie sont plus parcellaires. La tolérance semble bonne. Les résultats concernant l’efficacité incitent à sélectionner les patients qui pourraient bénéficier du traitement. Comme nous y encourage l’European Medicines Agency, construisons des études dédiées aux patients fragiles et incluons-les dans les essais, afin qu’ils bénéficient, comme les autres, de l’innovation thérapeutique. Pour que les résultats de la recherche clinique soient applicables à une large population, les populations dites particulières doivent être représentées plus largement.
1877-1203/© 2023 SPLF. Publié par Elsevier Masson SAS. Tous droits réservés.
Performance status (PS) is a measure of the patient’s overall condition. Karnofsky and ECOG (Eastern Cooperative Oncology Group) are the most widely used scales. A three-point conversion scale allows a strong correlation between both scores: ECOG 0-1 = Karnofsky 100-80 %, ECOG 2 = Karnofsky 60-70 %, ECOG 3-4 = Karnofsky 50-10 %. Numerous factors, whether linked to cancer or to comorbidities, can affect PS. PS remains a major independent prognostic factor in NSCLC (non small cell lung cancer) and SCLC (small cell lung cancer), despite its flawed reproducibility and the heterogeneity of cancer patients with poor PS. As a matter of fact, PS should be regarded as a stratification factor in research. All guidelines take PS into account as a therapeutic decision making tool, especially in the case of chemotherapy for metastatic NSCLC. Targeted therapy should be considered in case of metastatic disease with molecular targets regardless of PS, for its high effectiveness and good safety profile. Data regarding immunotherapy are rather sketchy. Tolerance seems to be fine. Findings regarding efficacy warrant careful selection of patients who might benefit from this therapy. In light of the European Medicines Agency call, let us build studies dedicated to patients as frail as they come and enroll them in clinical trials in such a way that they benefit, among others, from therapeutic advances. In order to apply clinical research findings to the general population, specific groups of patients should be more involved.
1877-1203/© 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.

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^☆: This paper was presented in part at the 1994 ASCO Annual Meeting, 14–17 May, Dallas, Texas, U.S.A.

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Original paperKarnofsky and ECOG performance status scoring in lung cancer: A prospective, longitudinal study of 536 patients from a single institution☆

Abstract

J Chron Dis

Eur J Cancer

Chest

Eur J Cancer

Cancer of the lung

Performance status assessment among oncology patients: a review

Cancer Treat Rep

Symptomatic, stage IV, non-small-cell lung cancer (NSCLC): response, toxicity, performance status change and symptom relief in patients treated with cisplatin, vinblastine and mitomycin-C

Cancer Chemother Pharmacol

Quality of life assessment. An independent prognostic variable for survival in lung cancer

Cancer

Performance and prognosis in patients with lung cancer

Thorax

Prognostic factors in lung cancer: tables and comments

Eur Resp J

The clinical evaluation of chemotherapeutic agents in cancer

The Karnofsky performance status scale. An examination of its reliability and validity in a research setting

Cancer

Karnofsky performance status revised: reliability, validity, and guidelines

J Clin Oncol

Performance status assessment in cancer patients

Cancer

Original paper
Karnofsky and ECOG performance status scoring in lung cancer: A prospective, longitudinal study of 536 patients from a single institution☆