title: One-Year Mortality in Older Patients with Cancer: Development and External Validation of an MNA-Based Prognostic Score.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Clinical Gerontology Department, CHU Bordeaux, Bordeaux, France.|RMSB, UMR 5536, CNRS, Bordeaux, France.|RMSB, UMR 5536, Bordeaux University, Bordeaux, France.
authors: Isabelle
authors: I
authors: Bourdel-Marchasson
authors: Clinical Epidemiology Unit, CHU Bordeaux, Bordeaux, France.
authors: Abou
authors: A
authors: Diallo
authors: CIC-14.01, INSERM, Bordeaux, France.|Clinical Research and Clinical Epidemiology Unit, Institut Bergonié, Bordeaux, France.
authors: Carine
authors: C
authors: Bellera
authors: Clinical Gerontology Department, CHU Bordeaux, Bordeaux, France.
authors: Christelle
authors: C
authors: Blanc-Bisson
authors: Clinical Gerontology Department, CHU Bordeaux, Bordeaux, France.
authors: Jessica
authors: J
authors: Durrieu
authors: Clinical Epidemiology Unit, CHU Bordeaux, Bordeaux, France.
authors: Christine
authors: C
authors: Germain
authors: CIC-14.01, INSERM, Bordeaux, France.|Clinical Research and Clinical Epidemiology Unit, Institut Bergonié, Bordeaux, France.
authors: Simone
authors: S
authors: Mathoulin-Pélissier
authors: Medical Oncology Department, Institut Bergonié, Bordeaux, France.|Bordeaux University, Bordeaux, France.
authors: Pierre
authors: P
authors: Soubeyran
authors: Clinical Gerontology Department, CHU Bordeaux, Bordeaux, France.|Bordeaux University, Bordeaux, France.
authors: Muriel
authors: M
authors: Rainfray
authors: Medical Oncology Department, Institut Bergonié, Bordeaux, France.
authors: Mariane
authors: M
authors: Fonck
authors: Clinical Epidemiology Unit, CHU Bordeaux, Bordeaux, France.|CIC-14.01, INSERM, Bordeaux, France.
authors: Adelaïde
authors: A
authors: Doussau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002100:Cachexia / Q000209:etiology / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000178:diet therapy / Q000188:drug therapy / Q000401:mortality*; D015596:Nutrition Assessment; D009752:Nutritional Status; D011379:Prognosis; D011446:Prospective Studies