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

• Published in: PloS one Vol. 11; no. 2; p. e0148523
• Main Authors: Bourdel-Marchasson, Isabelle, Diallo, Abou, Bellera, Carine, Blanc-Bisson, Christelle, Durrieu, Jessica, Germain, Christine, Mathoulin-Pélissier, Simone, Soubeyran, Pierre, Rainfray, Muriel, Fonck, Mariane, Doussau, Adelaïde
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 09.02.2016; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Analysis; Biology and Life Sciences; Body weight loss; Cachexia; Cachexia - etiology; Cachexia - mortality; Cancer; Cancer therapies; Cell number; Chemotherapy; Cohort Studies; Colon; Comorbidity; Diet; Dietary intake; Drugs; Elderly patients; Epidemiology; Fatalities; Female; Food intake; France - epidemiology; Geriatric Assessment; Geriatrics; Gerontology; Health aspects; Heart failure; Humans; Indication; Life Sciences; Logistic Models; Lung cancer; Lymphocytes; Lymphoma; Male; Malnutrition; Mathematical models; Medical prognosis; Medicine and Health Sciences; Metastases; Metastasis; Mortality; Multivariate Analysis; Neoplasms - diet therapy; Neoplasms - drug therapy; Neoplasms - mortality; Nutrition; Nutrition Assessment; Nutritional Status; Older people; Oncology; Patient outcomes; Patients; People and Places; Prognosis; Prospective Studies; Prostate; Regression analysis; France
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0148523

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. 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. 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. 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.