Model-Based Prognostication and Symptom Distress in Patients with Advanced Hepatopancreaticobiliary Cancers Receiving Best Supportive Care: A Prospective Cohort Study.

PURPOSE: Metastatic hepatopancreaticobiliary (HPB) cancers often exhibit rapid and aggressive progression. Accurate prognostication is essential for aligning care objectives and preventing futile interventions. The Palliative Prognostic Index (PPI) is a simple, validated bedside tool for advanced cancers, but its efficacy in metastatic HPB malignancies remains unassessed. This study aimed to evaluate the predictive accuracy of the PPI and to describe the symptom burden in this patient population. METHODS: We conducted a prospective observational cohort study of adults with metastatic HPB cancers referred for specialist palliative care from September 2022 to May 2023 who were not receiving any disease directed treatment. Baseline PPI scores were determined by palliative care physicians and survival was documented for 90 days. Symptom burden was assessed using the Edmonton Symptom Assessment Scale (ESAS). The prognostic performance of the PPI was evaluated using c-statistic and sensitivity-specificity analyses. RESULTS: Among 145 participants, 123 (84.8%) died within 90 days. Median actual survival was 24 days (95% CI: 20.8–27.2). PPI showed good discrimination (c = 0.78 at 7 days, 0.71 at 21 days). Higher PPI categories were significantly associated with greater mortality risk (HR 2.61, 95% CI: 1.56–4.36). Performance status and presence of abdominal pain independently predicted mortality. Significant baseline symptom distress was seen, with modest alleviation after palliative care integration. CONCLUSION: In metastatic HPB cancers, PPI offers a practical and specific adjunct to clinical judgment for short-term survival estimation in palliative settings. Further validation in disease specific cohorts is needed to improve prognostic precision and guide care planning in patients with advanced cancer. TRN: CTRI/2022/08/044932 Date of registration:25/08/2022.