Development of an oncological-multidimensional prognostic index (Onco-MPI) for mortality prediction in older cancer patients

Antonella Brunello, Andrea Fontana, Valeria Zafferri, Francesco Panza, Pasquale Fiduccia, Umberto Basso, Massimiliano Copetti, Sara Lonardi, Anna Roma, Cristina Falci, Silvio Monfardini, Alberto Cella, A. Pilotto, Vittorina Zagonel

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Abstract

Purpose: Amultidimensional prognostic index (MPI) based on a comprehensive geriatric assessment (CGA) has been developed and validated in independent cohorts of older patients demonstrating good accuracy in predicting one-year mortality. The aim of this study was to develop a cancer-specific modified MPI (Onco-MPI) for mortality prediction in older cancer patients. Methods: We enrolled 658 new cancer subjects ≥70 years (mean age 77.1 years, 433 females, 65.8 %) attending oncological outpatient services from September 2004 to June 2011. The Onco-MPI was calculated according to a validated algorithm as a weighted linear combination of the following CGA domains: age, sex, basal and instrumental activities of daily living, Eastern Cooperative Oncology Group performance status, mini-mental state examination, body mass index, Cumulative Illness Rating Scale, number of drugs and the presence of caregiver. Cancer sites (breast 46.5 %, colorectal 21.3 %, lung 6.4 %, prostate 5.5 %, urinary tract 5.0 %, other 15.3 %) and cancer stages (I 37 %, II 22 %, III 19 %, IV 22 %) were also included in the model. All-cause mortality was recorded. Three grades of severity of the Onco-MPI score (low risk: 0.0–0.46, medium risk: 0.47–0.63, high risk: 0.64–1.0) were calculated using RECPAM method. Discriminatory power and calibration were assessed by estimating survival C-indices, along with 95 % confidence interval (CI) and the survival-based Hosmer–Lemeshow (HL) measures. Results: One-year mortality incidence rate was 17.4 %. A significant difference in mortality rates was observed in Onco-MPI low risk compared to medium- and high-risk patients (2.1 vs. 17.7 vs. 80.8 %, p <0.0001). The discriminatory power of one-year mortality prediction of the Onco-MPI was very good (survival C-index 0.87, 95 % CI 0.84–0.90) with an excellent calibration (HL p value 0.854). Conclusion: Onco-MPI appears to be a highly accurate and well-calibrated predictive tool for one-year mortality in older cancer patients that can be useful for clinical decision making in this age group.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalJournal of Cancer Research and Clinical Oncology
DOIs
Publication statusAccepted/In press - Jan 12 2016

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Mortality
Neoplasms
Geriatric Assessment
Calibration
Survival
Confidence Intervals
Ambulatory Care
Activities of Daily Living
Urinary Tract
Caregivers
Prostate
Body Mass Index
Age Groups
Breast Neoplasms
Lung
Incidence
Pharmaceutical Preparations

Keywords

  • Cancer
  • Comprehensive geriatric assessment (CGA)
  • Elderly
  • Mortality
  • Multidimensional prognostic index (MPI)
  • Prognosis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

@article{76022ec8c9544856a073b4016f2e916e,
title = "Development of an oncological-multidimensional prognostic index (Onco-MPI) for mortality prediction in older cancer patients",
abstract = "Purpose: Amultidimensional prognostic index (MPI) based on a comprehensive geriatric assessment (CGA) has been developed and validated in independent cohorts of older patients demonstrating good accuracy in predicting one-year mortality. The aim of this study was to develop a cancer-specific modified MPI (Onco-MPI) for mortality prediction in older cancer patients. Methods: We enrolled 658 new cancer subjects ≥70 years (mean age 77.1 years, 433 females, 65.8 {\%}) attending oncological outpatient services from September 2004 to June 2011. The Onco-MPI was calculated according to a validated algorithm as a weighted linear combination of the following CGA domains: age, sex, basal and instrumental activities of daily living, Eastern Cooperative Oncology Group performance status, mini-mental state examination, body mass index, Cumulative Illness Rating Scale, number of drugs and the presence of caregiver. Cancer sites (breast 46.5 {\%}, colorectal 21.3 {\%}, lung 6.4 {\%}, prostate 5.5 {\%}, urinary tract 5.0 {\%}, other 15.3 {\%}) and cancer stages (I 37 {\%}, II 22 {\%}, III 19 {\%}, IV 22 {\%}) were also included in the model. All-cause mortality was recorded. Three grades of severity of the Onco-MPI score (low risk: 0.0–0.46, medium risk: 0.47–0.63, high risk: 0.64–1.0) were calculated using RECPAM method. Discriminatory power and calibration were assessed by estimating survival C-indices, along with 95 {\%} confidence interval (CI) and the survival-based Hosmer–Lemeshow (HL) measures. Results: One-year mortality incidence rate was 17.4 {\%}. A significant difference in mortality rates was observed in Onco-MPI low risk compared to medium- and high-risk patients (2.1 vs. 17.7 vs. 80.8 {\%}, p <0.0001). The discriminatory power of one-year mortality prediction of the Onco-MPI was very good (survival C-index 0.87, 95 {\%} CI 0.84–0.90) with an excellent calibration (HL p value 0.854). Conclusion: Onco-MPI appears to be a highly accurate and well-calibrated predictive tool for one-year mortality in older cancer patients that can be useful for clinical decision making in this age group.",
keywords = "Cancer, Comprehensive geriatric assessment (CGA), Elderly, Mortality, Multidimensional prognostic index (MPI), Prognosis",
author = "Antonella Brunello and Andrea Fontana and Valeria Zafferri and Francesco Panza and Pasquale Fiduccia and Umberto Basso and Massimiliano Copetti and Sara Lonardi and Anna Roma and Cristina Falci and Silvio Monfardini and Alberto Cella and A. Pilotto and Vittorina Zagonel",
year = "2016",
month = "1",
day = "12",
doi = "10.1007/s00432-015-2088-x",
language = "English",
pages = "1--9",
journal = "Journal of Cancer Research and Clinical Oncology",
issn = "0171-5216",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Development of an oncological-multidimensional prognostic index (Onco-MPI) for mortality prediction in older cancer patients

AU - Brunello, Antonella

AU - Fontana, Andrea

AU - Zafferri, Valeria

AU - Panza, Francesco

AU - Fiduccia, Pasquale

AU - Basso, Umberto

AU - Copetti, Massimiliano

AU - Lonardi, Sara

AU - Roma, Anna

AU - Falci, Cristina

AU - Monfardini, Silvio

AU - Cella, Alberto

AU - Pilotto, A.

AU - Zagonel, Vittorina

PY - 2016/1/12

Y1 - 2016/1/12

N2 - Purpose: Amultidimensional prognostic index (MPI) based on a comprehensive geriatric assessment (CGA) has been developed and validated in independent cohorts of older patients demonstrating good accuracy in predicting one-year mortality. The aim of this study was to develop a cancer-specific modified MPI (Onco-MPI) for mortality prediction in older cancer patients. Methods: We enrolled 658 new cancer subjects ≥70 years (mean age 77.1 years, 433 females, 65.8 %) attending oncological outpatient services from September 2004 to June 2011. The Onco-MPI was calculated according to a validated algorithm as a weighted linear combination of the following CGA domains: age, sex, basal and instrumental activities of daily living, Eastern Cooperative Oncology Group performance status, mini-mental state examination, body mass index, Cumulative Illness Rating Scale, number of drugs and the presence of caregiver. Cancer sites (breast 46.5 %, colorectal 21.3 %, lung 6.4 %, prostate 5.5 %, urinary tract 5.0 %, other 15.3 %) and cancer stages (I 37 %, II 22 %, III 19 %, IV 22 %) were also included in the model. All-cause mortality was recorded. Three grades of severity of the Onco-MPI score (low risk: 0.0–0.46, medium risk: 0.47–0.63, high risk: 0.64–1.0) were calculated using RECPAM method. Discriminatory power and calibration were assessed by estimating survival C-indices, along with 95 % confidence interval (CI) and the survival-based Hosmer–Lemeshow (HL) measures. Results: One-year mortality incidence rate was 17.4 %. A significant difference in mortality rates was observed in Onco-MPI low risk compared to medium- and high-risk patients (2.1 vs. 17.7 vs. 80.8 %, p <0.0001). The discriminatory power of one-year mortality prediction of the Onco-MPI was very good (survival C-index 0.87, 95 % CI 0.84–0.90) with an excellent calibration (HL p value 0.854). Conclusion: Onco-MPI appears to be a highly accurate and well-calibrated predictive tool for one-year mortality in older cancer patients that can be useful for clinical decision making in this age group.

AB - Purpose: Amultidimensional prognostic index (MPI) based on a comprehensive geriatric assessment (CGA) has been developed and validated in independent cohorts of older patients demonstrating good accuracy in predicting one-year mortality. The aim of this study was to develop a cancer-specific modified MPI (Onco-MPI) for mortality prediction in older cancer patients. Methods: We enrolled 658 new cancer subjects ≥70 years (mean age 77.1 years, 433 females, 65.8 %) attending oncological outpatient services from September 2004 to June 2011. The Onco-MPI was calculated according to a validated algorithm as a weighted linear combination of the following CGA domains: age, sex, basal and instrumental activities of daily living, Eastern Cooperative Oncology Group performance status, mini-mental state examination, body mass index, Cumulative Illness Rating Scale, number of drugs and the presence of caregiver. Cancer sites (breast 46.5 %, colorectal 21.3 %, lung 6.4 %, prostate 5.5 %, urinary tract 5.0 %, other 15.3 %) and cancer stages (I 37 %, II 22 %, III 19 %, IV 22 %) were also included in the model. All-cause mortality was recorded. Three grades of severity of the Onco-MPI score (low risk: 0.0–0.46, medium risk: 0.47–0.63, high risk: 0.64–1.0) were calculated using RECPAM method. Discriminatory power and calibration were assessed by estimating survival C-indices, along with 95 % confidence interval (CI) and the survival-based Hosmer–Lemeshow (HL) measures. Results: One-year mortality incidence rate was 17.4 %. A significant difference in mortality rates was observed in Onco-MPI low risk compared to medium- and high-risk patients (2.1 vs. 17.7 vs. 80.8 %, p <0.0001). The discriminatory power of one-year mortality prediction of the Onco-MPI was very good (survival C-index 0.87, 95 % CI 0.84–0.90) with an excellent calibration (HL p value 0.854). Conclusion: Onco-MPI appears to be a highly accurate and well-calibrated predictive tool for one-year mortality in older cancer patients that can be useful for clinical decision making in this age group.

KW - Cancer

KW - Comprehensive geriatric assessment (CGA)

KW - Elderly

KW - Mortality

KW - Multidimensional prognostic index (MPI)

KW - Prognosis

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U2 - 10.1007/s00432-015-2088-x

DO - 10.1007/s00432-015-2088-x

M3 - Article

SP - 1

EP - 9

JO - Journal of Cancer Research and Clinical Oncology

JF - Journal of Cancer Research and Clinical Oncology

SN - 0171-5216

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