{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T02:57:00Z","timestamp":1781233020163,"version":"3.54.1"},"reference-count":26,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Accurate prognostication in terminal cancer patients receiving best supportive care (BSC) is essential for guiding end-of-life decision-making and avoiding non-beneficial interventions. Several prognostic models have been developed for advanced cancer, including the Palliative Prognostic Index (PPI) and the Objective Prognostic Score (OPS). However, prospective data evaluating their performance specifically in patients managed with BSC are limited. This study evaluated the prognostic performance of PPI and OPS in terminal cancer patients receiving BSC. It also examined whether their combined use provides additional value for short-term mortality risk stratification. Methods: This prospective observational cohort study included hospitalized adult patients with terminal-stage cancer and a documented BSC decision. Terminal-stage cancer was operationally defined as stage IV malignancy with poor performance status and no remaining feasible disease-directed oncological treatment option due to severe clinical deterioration and\/or major organ dysfunction. Patients were prospectively enrolled from 12 April 2024 to 13 December 2024 and followed until death. Eligible patients had poor Eastern Cooperative Oncology Group performance status (ECOG 3\u20134) and had not received oncologic treatment within the preceding month. PPI and OPS were calculated at baseline using predefined criteria. Survival time was defined as the interval between baseline assessment and death. The prognostic performance of the scores for 3-, 4-, and 6-week mortality was evaluated, and survival outcomes were analyzed using standard survival analysis methods. Results: A total of 112 patients were included in the final analysis. The mean age was 62.3 \u00b1 12.3 years; 66 patients (58.9%) were male and 46 (41.1%) were female. The most common primary tumor sites were colon cancer (20.5%), non-small cell lung cancer (17.0%), and gastric cancer (15.2%). Both PPI &gt; 6 and OPS \u2265 3 were associated with higher short-term mortality, although their individual discriminatory performance was modest. The combined OPS\u2013PPI approach showed statistically significant but still modest discrimination at all time points. Although this difference was limited, the combined approach supported the stratification of a clinically relevant subgroup at particularly high risk of imminent death. Patients with both OPS \u2265 3 and PPI &gt; 6 had the poorest survival, with a median overall survival (OS) of 11 days. In multivariable Cox regression analysis, the combined high-risk group remained independently associated with poorer OS (HR 1.53, 95% CI 1.01\u20132.31; p = 0.046). Conclusions: Although the individual discriminatory performance of PPI and OPS was modest, their combined use may provide additional risk stratification value and may help identify patients at particularly high risk of short-term mortality among terminal cancer patients receiving BSC. These findings should be interpreted as supporting bedside risk stratification rather than indicating a definitive individual-level prediction model.<\/jats:p>","DOI":"10.3390\/jcm15124502","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T02:59:31Z","timestamp":1781146771000},"page":"4502","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Value of the Objective Prognostic Score and Palliative Prognostic Index for Short-Term Mortality in Terminal Cancer Patients Receiving Best Supportive Care: A Prospective Observational Single-Center Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Alperen Akansel","family":"\u00c7a\u011flar","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital, Istanbul 34110, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6547-0199","authenticated-orcid":false,"given":"Zekeriya","family":"Hannarici","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa 16010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Emin","family":"B\u00fcy\u00fckbayram","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Yalova State Hospital, Yalova 77100, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2535-9816","authenticated-orcid":false,"given":"Aykut","family":"Turhan","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Ordu University Training and Research Hospital, Ordu 52200, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1174-9493","authenticated-orcid":false,"given":"Yasin Emrah","family":"Soylu","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Training and Research Hospital, Faculty of Medicine, Atat\u00fcrk University, Erzurum 25030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2850-6997","authenticated-orcid":false,"given":"Mehmet","family":"Bilici","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Training and Research Hospital, Faculty of Medicine, Atat\u00fcrk University, Erzurum 25030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim Ba\u015fol","family":"Tekin","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Acibadem Bursa Hospital, Bursa 16010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101195","DOI":"10.1016\/j.esmoop.2023.101195","article-title":"Prognostic evaluation in patients with advanced cancer in the last months of life: ESMO Clinical Practice Guideline","volume":"8","author":"Stone","year":"2023","journal-title":"ESMO Open"},{"key":"ref_2","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1136\/ewjm.172.5.310","article-title":"Extent and determinants of error in physicians\u2019 prognoses in terminally ill patients: Prospective cohort study","volume":"172","author":"Christakis","year":"2000","journal-title":"West. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1016\/j.ejca.2008.02.030","article-title":"Predicting survival in patients with advanced disease","volume":"44","author":"Glare","year":"2008","journal-title":"Eur. J. Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1177\/107327481502200415","article-title":"Prognostication of Survival in Patients with Advanced Cancer: Predicting the Unpredictable?","volume":"22","author":"Hui","year":"2015","journal-title":"Cancer Control"},{"key":"ref_6","first-page":"128","article-title":"The Palliative Prognostic Index: A scoring system for survival prediction of terminally ill cancer patients","volume":"7","author":"Morita","year":"1999","journal-title":"Support. Care Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.jpainsymman.2007.07.006","article-title":"Prospective validation of the palliative prognostic index in patients with cancer","volume":"35","author":"Stone","year":"2008","journal-title":"J. Pain Symptom Manag."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1177\/02692163231180657","article-title":"Performance of the Palliative Prognostic Index for cancer patients: A systematic review and meta-analysis","volume":"37","author":"Yoong","year":"2023","journal-title":"Palliat. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e80","DOI":"10.1017\/S1478951525000021","article-title":"Prognostic utility of Palliative Prognostic Index in advanced cancer: A systematic review and meta-analysis","volume":"23","author":"Yoong","year":"2025","journal-title":"Palliat. Support. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1177\/08258597231214896","article-title":"Comparison of Simplified Palliative Prognostic Index and Palliative Performance Scale in Patients with Advanced Cancer in a Home Palliative Care Setting","volume":"39","author":"Hiratsuka","year":"2024","journal-title":"J. Palliat. Care"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Fung, M.Y., Wong, Y.L., Cheung, K.M., Bao, K.H.K., and Sung, W.W.Y. (2025). Prognostic models for survival predictions in advanced cancer patients: A systematic review and meta-analysis. BMC Palliat. Care, 24.","DOI":"10.1186\/s12904-025-01696-4"},{"key":"ref_12","first-page":"151","article-title":"Construction of a new, objective prognostic score for terminally ill cancer patients: A multicenter study","volume":"18","author":"Suh","year":"2010","journal-title":"Support. Care Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.jpainsymman.2016.03.015","article-title":"Prospective Validation of the Objective Prognostic Score for Advanced Cancer Patients in Diverse Palliative Settings","volume":"52","author":"Jho","year":"2016","journal-title":"J. Pain Symptom Manag."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1177\/1049909113492557","article-title":"Retrospective assessment of objective prognostic score in terminally ill Korean patients with cancer","volume":"31","author":"Yoon","year":"2014","journal-title":"Am. J. Hosp. Palliat. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1089\/jpm.2016.0044","article-title":"Prospective Validation of Objective Prognostic Score for Advanced Cancer Inpatients in South Korea: A Multicenter Study","volume":"20","author":"Yoon","year":"2017","journal-title":"J. Palliat. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e1016","DOI":"10.1136\/bmjspcare-2021-003077","article-title":"Prognosis palliative care study, palliative prognostic index, palliative prognostic score and objective prognostic score in advanced cancer: A prospective comparison","volume":"14","author":"Lee","year":"2021","journal-title":"BMJ Support. Palliat. Care"},{"key":"ref_17","first-page":"662","article-title":"Comparison of Objective Prognostic Score and Palliative Prognostic Score performance in inpatients with advanced cancer in Japan and Korea","volume":"20","author":"Hiratsuka","year":"2022","journal-title":"Palliat. Support. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.jpainsymman.2024.04.022","article-title":"Comparison of Prognostic Abilities of Palliative Prognostic Index, Laboratory Prognostic Score, and Palliative Prognostic Score","volume":"68","author":"Yuasa","year":"2024","journal-title":"J. Pain Symptom Manag."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e588","DOI":"10.1016\/S1470-2045(18)30415-7","article-title":"Integration of oncology and palliative care: A Lancet Oncology Commission","volume":"19","author":"Kaasa","year":"2018","journal-title":"Lancet Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1016\/j.jpainsymman.2016.12.330","article-title":"Prognostic Tools in Patients with Advanced Cancer: A Systematic Review","volume":"53","author":"Simmons","year":"2017","journal-title":"J. Pain Symptom Manag."},{"key":"ref_21","first-page":"142","article-title":"Usefulness of Palliative Prognostic Index, Objective Prognostic Score, and Neutrophil-Lymphocyte Ratio\/Albumin Ratio As Prognostic Indicators for Patients Without Cancer Receiving Home-Visit Palliative Care: A Pilot Study at a Community General Hospital","volume":"5","author":"Hori","year":"2024","journal-title":"Palliat. Med. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.jpainsymman.2015.04.021","article-title":"Validation of the Simplified Palliative Prognostic Index Using a Single Item from the Communication Capacity Scale","volume":"50","author":"Hamano","year":"2015","journal-title":"J. Pain Symptom Manag."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1016\/j.ejca.2015.04.025","article-title":"Survival prediction for advanced cancer patients in the real world: A comparison of the Palliative Prognostic Score, Delirium-Palliative Prognostic Score, Palliative Prognostic Index and modified Prognosis in Palliative Care Study predictor model","volume":"51","author":"Baba","year":"2015","journal-title":"Eur. J. Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1056\/NEJMoa1000678","article-title":"Early palliative care for patients with metastatic non-small-cell lung cancer","volume":"363","author":"Temel","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2336","DOI":"10.1200\/JCO.24.00542","article-title":"Palliative Care for Patients with Cancer: ASCO Guideline Update","volume":"42","author":"Sanders","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"100225","DOI":"10.1016\/j.esmoop.2021.100225","article-title":"Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines","volume":"6","author":"Crawford","year":"2021","journal-title":"ESMO Open"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4502\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T02:15:11Z","timestamp":1781230511000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4502"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,10]]},"references-count":26,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124502"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124502","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,10]]}}}