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

Isabelle Bourdel-Marchasson (1) , Abou Diallo (2) , Carine Bellera (3) , Christelle Blanc-Bisson , Jessica Durrieu , Christine Germain , Simone S. Mathoulin-Pélissier (4) , Pierre Soubeyran (5) , Muriel Rainfray (6) , Mariane Fonck , Adélaïde Doussau (7)

1 Centre de Gériatrie
2 ISPED - Institut de Santé Publique, d'Epidémiologie et de Développement
3 Centre d'Investigation Clinique - Epidemiologie Clinique / Essais Cliniques Bordeaux
4 Centre Régional de lutte contre le Cancer du Sud-Ouest
5 Plateforme de génétique moléculaire des cancers d'Aquitaine
6 CHU Bordeaux
7 Epidémiologie et Biostatistique [Bordeaux]

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 <31cm (p = 0.0002), tumor origin (p<0.0001), metastatic status (p = 0.0007) and lym-phocyte count <1500/mm 3 (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.

Domaines: Sciences du Vivant [q-bio]

Isabelle Bourdel-Marchasson, Abou Diallo, Carine Bellera, Christelle Blanc-Bisson, Jessica Durrieu, et al.. One-Year Mortality in Older Patients with Cancer: Development and External Validation of an MNA-Based Prognostic Score. PLoS ONE, 2016, 11 (2), pp.e0148523. ⟨10.1371/journal.pone.0148523⟩. ⟨hal-02375559⟩