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Prognostic assessment in older adults with solid tumors: A multicenter comparison of Onco-MPI, Balducci's
Anna Garnier1, Nicolas Giraud2, Julie Biogeau3
1Department of Gerontology, Tours Regional University Hospital Center, France.
Introduction:
Older adults represent a growing proportion of patients with cancer, yet treatment decisions remain complex due to the heterogeneity of aging. Several geriatric composite indices are used in clinical practice, yet their comparative prognostic performance has not been clearly established in head-to-head comparisons. We studied the ability of Balducci's classification, the G8 and Onco-MPI scores to predict one-year mortality and overall survival (OS) in older adults with solid tumors.
Materials And Methods:
We conducted a multicenter observational study using a regional cancer database from three hospitals in Centre-Val de Loire, France. Patients aged ≥75 years who underwent a Comprehensive Geriatric Assessment (CGA) between 2014 and 2024 were included. One-year mortality was analyzed using receiver operating characteristics curves, while OS was assessed with Kaplan-Meier and Cox regression models. Discriminative performance was quantified using area under the curve (AUC) and Harrell's concordance index (C-index).
Results:
Among 822 patients (median age 84 years; 59% female; 44% metastatic disease), one-year mortality was 39.7%. The Onco-MPI showed the highest predictive accuracy for one-year mortality and OS (AUC 0.73 and C-index 0.65, respectively), outperforming the G8 score (AUC 0.65; C-index 0.60) and Balducci's classification (AUC 0.58; C-index 0.56) (all pairwise p < 0.001). Median OS was 19.5 months, differing significantly across risk groups for all indices (p < 0.001).
Discussion:
In older adults with solid tumors, the Onco-MPI provided the most accurate prognostic stratification. By integrating oncological and geriatric dimensions, this composite index may better support individualized decision-making in geriatric oncology.
