Prognostic value of the Nice Cancer Ageing Survival (NCAS) score in older adults with cancer: A retrospective single institutional study

Introduction Short-term prognostic tools may help identify older patients with cancer who are poor candidates for oncological treatments. The Nice Cancer Ageing Survival (NCAS) score was developed to assess the 100-day mortality risk among older patients with cancer after geriatric assessment (GA). We aimed to externally validate the predictivity of the NCAS score within an independent cohort of 70 years and older patients with cancer.Materials and methods Patients 70 years or older who underwent pre-therapeutic GA at Gustave Roussy between October 2022 and April 2025 were included. NCAS was calculated based on the GA results for all patients with complete data. The survival rate 100 days after the CGA was assessed according to the NCAS predefined risk groups.Results Between October 2022 and April 2025, 543 patients were included. Prognostic groups based on the NCAS classification were analyzed in 538 patients. The mortality rate 100 days after GA was 28%. The 100-day survival rates decreased progressively across risk categories; 95.5% (95% CI: 91.6-97.6) for 0-6 points, 88.1% (95% CI: 83.2-91.7) for 7-8 points, 78.8% (95% CI: 69.5-85.9) for 9-10 points, and 58.3% (95% CI: 33.6-79.5) for 11 points. Compared with patients scoring 0-6 points, the risk of 100-day mortality increased significantly: HR 2.40 (95% CI: 1.56-3.80) for 7-8 points, HR 4.34 (95% CI: 2.70-7.10) for 9-10 points, and HR 6.41 (95% CI: 2.84-13.12) for 11 points (p Discussion In this external validation cohort, the NCAS score was significantly associated with 100-day mortality, although its discriminative performance was modest. While the NCAS may provide complementary prognostic information to GA, it should not be used alone to guide treatment decisions in older adults with cancer. Further refinement and development of prognostic tools is warranted.