Abstract
PurposeThe 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.MethodsThe 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.ResultsAt 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 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.ConclusionKey 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.
Highlights
The question of prognosis is crucial before starting a treatment for cancer
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
The area under curve (AUC) of the score was 0.793, which was higher than the Full MNA AUC (0.706)
Summary
The question of prognosis is crucial before starting a treatment for cancer. The Comprehensive Geriatric Assessment (CGA) can offer a prognostic evaluation in older patients with cancer [1,2,3,4]. We have previously reviewed the central role of nutritional parameters in the CGA and their capacity to predict mortality in older people [5]. It is recommended by French Speaking Society of Clinical Nutrition and Metabolism (SFNEP) to screen malnutrition in patients during their treatment for cancer [6]. The suggested tools are weight loss search, dietary intake analogue scale, and multidimensional screening tools such as the full MNA (Mini Nutritional Assessment) in older, and the scored Patient-Generated Subjective Global Assessment (PG-SGA) in adult. The full-length scale includes most of the known prognostic factors in cancer [11,12,13,14,15] with the exception of disease-related prognostic factors
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