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Randomized Controlled Trial
. 2016 Feb 9;11(2):e0148523.
doi: 10.1371/journal.pone.0148523. eCollection 2016.

One-Year Mortality in Older Patients with Cancer: Development and External Validation of an MNA-Based Prognostic Score

Isabelle Bourdel-Marchasson  1   2   3 , Abou Diallo  4 , Carine Bellera  5   6 , Christelle Blanc-Bisson  1 , Jessica Durrieu  1 , Christine Germain  4 , Simone Mathoulin-Pélissier  5   6 , Pierre Soubeyran  7   8 , Muriel Rainfray  1   8 , Mariane Fonck  7 , Adelaïde Doussau  4   5
Affiliations
Randomized Controlled Trial

One-Year Mortality in Older Patients with Cancer: Development and External Validation of an MNA-Based Prognostic Score

Isabelle Bourdel-Marchasson et al. PLoS One. .

Abstract

Purpose: The MNA (Mini Nutritional Assessment) is known as a prognosis factor in older population. We analyzed the prognostic value for one-year mortality of MNA items in older patients with cancer treated with chemotherapy as the basis of a simplified prognostic score.

Methods: The prospective derivation cohort included 606 patients older than 70 years with an indication of chemotherapy for cancers. The endpoint to predict was one-year mortality. The 18 items of the Full MNA, age, gender, weight loss, cancer origin, TNM, performance status and lymphocyte count were considered to construct the prognostic model. MNA items were analyzed with a backward step-by-step multivariate logistic regression and other items were added in a forward step-by-step regression. External validation was performed on an independent cohort of 229 patients.

Results: At one year 266 deaths had occurred. Decreased dietary intake (p = 0.0002), decreased protein-rich food intake (p = 0.025), 3 or more prescribed drugs (p = 0.023), calf circumference <31 cm (p = 0.0002), tumor origin (p<0.0001), metastatic status (p = 0.0007) and lymphocyte count <1500/mm3 (0.029) were found to be associated with 1-year mortality in the final model and were used to construct a prognostic score. The area under curve (AUC) of the score was 0.793, which was higher than the Full MNA AUC (0.706). The AUC of the score in validation cohort (229 subjects, 137 deaths) was 0.698.

Conclusion: Key predictors of one-year mortality included cancer cachexia clinical features, comorbidities, the origin and the advanced status of the tumor. The prognostic value of this model combining a subset of MNA items and cancer related items was better than the full MNA, thus providing a simple score to predict 1-year mortality in older patients with an indication of chemotherapy.

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Conflict of interest statement

Competing Interests: AMGEN company is one of the funders of INOGAD study (Bourdel-Marchasson I, Blanc-Bisson C, Doussau A et al. Nutritional Advice in Older Patients at Risk of Malnutrition during Treatment for Chemotherapy: A Two-Year Randomized Controlled Trial. PLoS One 2014; 9: e108687). AMGEN was not involved in the design of the trial, in the collection, analysis, interpretation or publication of the results of the INOGAD trial. In addition, the INOGAD trial was examining the impact of a nutritional intervention, and did not include any specific recommendations regarding the use of medications produced by AMGEN. In INOGAD study e-CRF the question of injection of erythropoietin or G-CSF (Granulocyte colony-stimulating factor) from any brand is asked at each chemotherapy session. These data are only available for patients at risk for malnutrition who were randomized in the above intervention study. The authors have not analyzed yet these data. The content of the current paper is not related to the therapeutic use of these two families of drugs. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Fig 1
Fig 1. Flow chart of patients included in derivative cohort based on screening for participation in randomized controlled study and in validation cohort.
Fig 2
Fig 2. ROC curves of predictive score among derivative population (A) and validation population (B) and respective calibration plots (C and D).
Vertical bars correspond to 95%.
See this image and copyright information in PMC

References

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