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Mekhail Extension of the Motzer Score

Calculators  Oncology
Mekhail Extension of the Motzer Score predicts prognosis of survival rate of metastatic renal cell carcinoma.
LDH >1.5× upper limit of normal
Normal: 140 U/L
No 0
Yes 1
Hemoglobin level <lower limit of normal
Normal: <12 g/dL (120 g/L)
No 0
Yes 1
Corrected serum calcium level >10 mg/dL (2.5 mmol/L)
No 0
Yes 1
Time from initial diagnosis upto systemic treatment <1 year
No 0
Yes 1
Prior treatment with radiation
No 0
Yes 1
>=2 sites of metastasis
No 0
Yes 1
Result:

Background

Measured Factor
Mekhail score
Measured Factor Disease
  • Metastatic Renal Cell Carcinoma
Measured Factor Detail
Mekhail score predicts prognosis of survival months based on the hemoglobin level, LDH level, serum calcium level, initial diagnosis time for treatment, radiation treatment, and number of metastesis sites. Score 0-1 indicates low risk with 28 months of survival, Score 2 indicates intermediate risk with 14 months of survival, and Score > or = 3 indicates high risk with 5 months of survival with metastetic renal cell carcinoma.
Speciality
Oncologist
Body System
Oncology
Measured Factor High Impact
  • Decrease in survival rate
Process
Calculating serum lactate dehydrogenase (LDH) level using lactate dehydrogenase (LDH) test to check increase or decrease level of LDH as compare to normal level of LDH | Calculating hemoglobin level by hemoglobin test to check increase or decrease level of LDH as compare to normal hemoglobin level | Calculating serum calcium level by serum calcium test to detect the calcium level as compared to normal calcium level.
Preparation
  • Pectus excavatum disease can interfere with LDH levels

Result Interpretation

Ranges Ranges
  • Critical High: Score > or = 3
  • Normal: Score 0-1
  • Normal Adult Male: Score 0-1
  • Normal Adult Female: Score 0-1
  • Normal Geriatric Male: Score 0-1
  • Normal Geriatric Female: Score 0-1
Result High Conditions
  • Metastatic Renal Cell Carcinoma
False Positive
  • Pectus excavatum disease can interfere with LDH levels
References: 2
Test Limitations
The score has not been applied successfully to patients in common practice or those receiving modern targeted therapies such as sunitinib.
References: 3

Studies

Study Validation 1
The aim of this study was to validate the prognostic factors for survival in patients with metastatic renal cell carcinoma (mRCC) receiving targeted therapy. A total of 336 patients treated with metastatic renal cell carcinoma (mRCC) were involved in the study. Patients were classified according to Motzer classification in low (32%), intermediate (48%) and poor risk (20%). Overall survival was evaluated in patients receiving Targeted therapies and median OS was found to be 24 months. This study concluded that Motzer classification was validated as independent prognostic factor to measure OS in patients with mRCC given TT.
References: 4
Study Validation 2
The aim of this study was to validate the Motzer classification model for survival in subjects with untreated metastatic renal cell carcinoma (RCC).Data from 353 patients was taken who were untreated with metastatic renal cell carcinoma (RCC).Motzer classification was utilized to classify the patients into low (19%)  , intermediate (70%) and poor risk (11%) groups. Results showed that Median overall survival for three groups were: 28.6, 14.6, and 4.5 months, respectively (P < .0001). Earlier radiotherapy and presence of hepatic, lung, and retroperitoneal nodal metastases were additional prognostic factors measured by Motzer classification model. This study concluded that by inclusion of additional parameters Mozter classification can be improved to define patients into risk categories
References: 1
Study Validation 3
This study aimed to investigate the prognostic factors related with overall survival (OS) and progression-free survival (PFS) in patients with metastatic renal cell carcinoma (RCC). A total 77 patients with metastatic RCC who were administered sunitinib with continuous once daily therapy. In memorial Sloan–Kettering Cancer Center (MSKCC) score poor OS and PFS was correlated with prognostic variables such as low hemoglobin, high corrected serum calcium, and high lactate dehydrogenase, hypoalbuminemia, and liver metastasis. The application of the MSKCC model evidently separated the PFS and OS curves (p < 0.001). This study concluded that MSKCC model is bettere model to predict the survival rates in patients with with metastatic renal cell carcinoma.
References: 5
Study Additional 1
The purpose of this prospective study was to define the prognostic criteria for patients with metastatic renal cell carcinoma (RCC) and was given interferon-alfa as initial systemic therapy. A total of 463 eligible patients were involved in the study and were divided into 3 risk categories (favorable, intermediate, poor) by a stratified Cox proportional hazards model. The median overall survival and progression time was 13 months and 4.7 months respectively. This study concluded that this prognostic model was adequate for risk quantification of trials utilizing interferon-alpha as the comparative treatment cohort
References: 6
Study Additional 2
The aim of the study was to investigate the prognostic factors and a model for predicting overall survival in 670 patients with metastatic renal-cell carcinoma (RCC). Proportional hazards regression was used to calculate the overall survival using Memorial Sloan-Kettering Cancer Center motzer-score . Results showed that patients falling under poor risk group had minimal survival time of 4 months when compared with other 2 groups. The study concluded that this multivariable model was accurately able to predict the five prognostic factors for predicting survival and to classify the patients based on their risk score.
References: 7

References

  1. Mekhail TM, Abou-jawde RM, Boumerhi G, Malhi S, Wood L, Elson P, et al. Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma. J Clin Oncol. 2005;23(4):832-41.
  2. Kim JJ, Kim CK, Park HJ, et al. Elevation of serum lactate dehydrogenase in patients with pectus excavatum. J Cardiothorac Surg. 2014;9:75.
  3. Bamias A, Karadimou A, Lampaki S, Lainakis G, Malettou L, Timotheadou E, et al. Prognostic stratification of patients with advanced renal cell carcinoma treated with sunitinib: comparison with the Memorial Sloan-Kettering prognostic factors model. BMC Cancer. 2010;10:45.
  4. Procopio G, Verzoni E, Iacovelli R, Biasoni D, Testa I, Porcu L, et al. Prognostic factors for survival in patients with metastatic renal cell carcinoma treated with targeted therapies. Br J Cancer. 2012;107(8):1227-32.
  5. Yildiz I, Sen F, Kilic L, Ekenel M, Ordu C, Kilicaslan I, et al. Prognostic factors associated with the response to sunitinib in patients with metastatic renal cell carcinoma. Curr Oncol. 2013;20(6):e546-53.
  6. Motzer RJ, Bacik J, Murphy BA, Russo P, Mazumdar M. Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol. 2002;20(1):289-96.
  7. Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol. 1999;17(8):2530-40.