title: Development of an oncological-multidimensional prognostic index (Onco-MPI) for mortality prediction in older cancer patients.
abstract: OBJECTIVE
  A multidimensional 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy. antonella.brunello@ioveneto.it.
authors.forename: Antonella
authors.identifier: http://orcid.org/0000-0003-2583-5226
authors.initials: A
authors.lastname: Brunello
authors.affiliation: IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fontana
authors.affiliation: Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Zafferri
authors.affiliation: IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.|Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Panza
authors.affiliation: Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Fiduccia
authors.affiliation: Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Basso
authors.affiliation: IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Copetti
authors.affiliation: Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Lonardi
authors.affiliation: Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Roma
authors.affiliation: Medical Oncology 2, Istituto Oncologico Veneto IOV- IRCCS, Padua, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Falci
authors.affiliation: IRCCS Fondazione Don Gnocchi, Milan, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Monfardini
authors.affiliation: Department of OrthoGeriatrics, Rehabilitation and Stabilization, Frailty Area, NR-HS Galliera Hospital, Genoa, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cella
authors.affiliation: Department of OrthoGeriatrics, Rehabilitation and Stabilization, Frailty Area, NR-HS Galliera Hospital, Genoa, Italy.|Geriatrics Unit, Azienda ULSS 16, S Antonio Hospital, Padua, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pilotto
authors.affiliation: Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy.
authors.forename: Vittorina
authors.initials: V
authors.lastname: Zagonel
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data*; D008297:Male; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D015996:Survival Rate
keywords: Cancer; Comprehensive geriatric assessment (CGA); Elderly; Mortality; Multidimensional prognostic index (MPI); Prognosis