# IMDC (Heng 2009)

IMDC

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/imdc`
HTML: https://magentlab.com/docs/imdc
Markdown: https://magentlab.com/docs/imdc.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Sum the Heng 2009 IMDC adverse factors for metastatic RCC treated with VEGF-targeted agents and return favorable (0), intermediate (1–2), or poor (3–6). Heng 2009 reported 2-year OS 75% (median not reached), 53% (median 27 months), and 7% (median 8.8 months) in those groups.

## When to use

When an agent needs the published Heng 2009 IMDC point total and risk group and must not invent an RCC diagnosis or treatment recommendation, and must not assign KPS or compare labs to institutional LLN/ULN.

## When not to use

- Not a medical device and not an RCC diagnosis or treatment recommendation. magent does not examine the patient.
- Heng 2009 overall-survival figures are published cohort results, not a treatment choice.
- magent does not assign Karnofsky performance status or compare hemoglobin, corrected calcium, neutrophils, or platelets to institutional LLN/ULN. All six inputs are caller-assigned flags.

## Formula

```
IMDC = kps_lt_80 1 + diagnosis_to_treatment_lt_1_year 1 + hemoglobin_lt_lln 1 + corrected_calcium_gt_uln 1 + neutrophils_gt_uln 1 + platelets_gt_uln 1; Heng 2009; max 6; favorable 0, intermediate 1-2, poor ≥3
```

## Citation

[Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study](https://doi.org/10.1200/JCO.2008.21.4809)
Heng DY, Xie W, Regan MM, Warren MA, Golshayan AR, Sahi C, Eigl BJ, Ruether JD, Cheng T, North S, Venner P, Knox JJ, Chi KN, Kollmannsberger C, McDermott DF, Rini BI, Bukowski RM, Rha SY, Choueiri TK
J Clin Oncol. 2009;27(34):5794-5799
DOI: [10.1200/JCO.2008.21.4809](https://doi.org/10.1200/JCO.2008.21.4809)

## Worked example

### All flags false

Given: `corrected_calcium_gt_uln=false, diagnosis_to_treatment_lt_1_year=false, hemoglobin_lt_lln=false, kps_lt_80=false, neutrophils_gt_uln=false, platelets_gt_uln=false`

1. All six caller-assigned flags false → 0
2. Score = 0 (max 6); imdc_band = favorable


### KPS <80, diagnosis-to-treatment <1 year, and hemoglobin <LLN

Given: `corrected_calcium_gt_uln=false, diagnosis_to_treatment_lt_1_year=true, hemoglobin_lt_lln=true, kps_lt_80=true, neutrophils_gt_uln=false, platelets_gt_uln=false`

1. kps_lt_80 → 1; diagnosis_to_treatment_lt_1_year → 1; hemoglobin_lt_lln → 1; remaining flags 0
2. Score = 3 (max 6); imdc_band = poor (≥3)


## Also searched as

- IMDC
- Heng score
- metastatic RCC risk
- International Metastatic RCC Database Consortium
- Heng 2009
- IMDC risk
- VEGF-targeted RCC prognosis
- Karnofsky IMDC

## Parameters

- `kps_lt_80` (boolean, required): Karnofsky performance status <80 as assigned by the caller (Heng 2009). true scores 1. magent does not assign KPS.
- `diagnosis_to_treatment_lt_1_year` (boolean, required): Time from diagnosis to systemic treatment <1 year as assigned by the caller (Heng 2009). true scores 1. magent does not date the interval.
- `hemoglobin_lt_lln` (boolean, required): Hemoglobin below the institutional lower limit of normal as assigned by the caller (Heng 2009). true scores 1. magent does not assay hemoglobin or apply LLN.
- `corrected_calcium_gt_uln` (boolean, required): Corrected calcium above the institutional upper limit of normal as assigned by the caller (Heng 2009). true scores 1. magent does not assay calcium or apply ULN.
- `neutrophils_gt_uln` (boolean, required): Neutrophils above the institutional upper limit of normal as assigned by the caller (Heng 2009). true scores 1. magent does not assay ANC or apply ULN.
- `platelets_gt_uln` (boolean, required): Platelets above the institutional upper limit of normal as assigned by the caller (Heng 2009). true scores 1. magent does not assay platelets or apply ULN.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/imdc`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "corrected_calcium_gt_uln": "false",
      "diagnosis_to_treatment_lt_1_year": "false",
      "hemoglobin_lt_lln": "false",
      "kps_lt_80": "false",
      "neutrophils_gt_uln": "false",
      "platelets_gt_uln": "false"
    },
    {
      "corrected_calcium_gt_uln": "false",
      "diagnosis_to_treatment_lt_1_year": "false",
      "hemoglobin_lt_lln": "false",
      "kps_lt_80": "false",
      "neutrophils_gt_uln": "false",
      "platelets_gt_uln": "false"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/imdc

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/imdc",
  "items": [
    {
      "components": [
        {
          "factor": "kps_lt_80",
          "points": 0,
          "present": false
        },
        {
          "factor": "diagnosis_to_treatment_lt_1_year",
          "points": 0,
          "present": false
        },
        {
          "factor": "hemoglobin_lt_lln",
          "points": 0,
          "present": false
        },
        {
          "factor": "corrected_calcium_gt_uln",
          "points": 0,
          "present": false
        },
        {
          "factor": "neutrophils_gt_uln",
          "points": 0,
          "present": false
        },
        {
          "factor": "platelets_gt_uln",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Heng DY, Xie W, Regan MM, Warren MA, Golshayan AR, Sahi C, Eigl BJ, Ruether JD, Cheng T, North S, Venner P, Knox JJ, Chi KN, Kollmannsberger C, McDermott DF, Rini BI, Bukowski RM, Rha SY, Choueiri TK",
        "doi": "10.1200/JCO.2008.21.4809",
        "id": "heng-2009",
        "pmid": "19826129",
        "source": "J Clin Oncol. 2009;27(34):5794-5799",
        "title": "Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study"
      },
      "formula": "imdc",
      "formula_expression": "IMDC = kps_lt_80 1 + diagnosis_to_treatment_lt_1_year 1 + hemoglobin_lt_lln 1 + corrected_calcium_gt_uln 1 + neutrophils_gt_uln 1 + platelets_gt_uln 1; Heng 2009; max 6; favorable 0, intermediate 1-2, poor ≥3",
      "max_score": 6,
      "score": 0,
      "imdc_band": "favorable"
    },
    {
      "components": [
        {
          "factor": "kps_lt_80",
          "points": 0,
          "present": false
        },
        {
          "factor": "diagnosis_to_treatment_lt_1_year",
          "points": 0,
          "present": false
        },
        {
          "factor": "hemoglobin_lt_lln",
          "points": 0,
          "present": false
        },
        {
          "factor": "corrected_calcium_gt_uln",
          "points": 0,
          "present": false
        },
        {
          "factor": "neutrophils_gt_uln",
          "points": 0,
          "present": false
        },
        {
          "factor": "platelets_gt_uln",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Heng DY, Xie W, Regan MM, Warren MA, Golshayan AR, Sahi C, Eigl BJ, Ruether JD, Cheng T, North S, Venner P, Knox JJ, Chi KN, Kollmannsberger C, McDermott DF, Rini BI, Bukowski RM, Rha SY, Choueiri TK",
        "doi": "10.1200/JCO.2008.21.4809",
        "id": "heng-2009",
        "pmid": "19826129",
        "source": "J Clin Oncol. 2009;27(34):5794-5799",
        "title": "Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study"
      },
      "formula": "imdc",
      "formula_expression": "IMDC = kps_lt_80 1 + diagnosis_to_treatment_lt_1_year 1 + hemoglobin_lt_lln 1 + corrected_calcium_gt_uln 1 + neutrophils_gt_uln 1 + platelets_gt_uln 1; Heng 2009; max 6; favorable 0, intermediate 1-2, poor ≥3",
      "max_score": 6,
      "score": 0,
      "imdc_band": "favorable"
    }
  ]
}
```

## Response fields

- `formula` (string): imdc
- `formula_expression` (string): Exact expression used
- `score` (integer): IMDC points 0-6
- `max_score` (integer): Always 6
- `imdc_band` (string): favorable when score is 0 (Heng 2009: 2-year OS 75%; median OS not reached), intermediate when 1–2 (median OS 27 months; 2-year OS 53%), poor when 3–6 (median OS 8.8 months; 2-year OS 7%). Not an RCC diagnosis or treatment recommendation. Caller assigns KPS and lab flags versus institutional LLN/ULN.
- `components` (array): Per-factor points
- `citation` (object): Heng 2009 J Clin Oncol citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "factor": "kps_lt_80",
      "points": 0,
      "present": false
    },
    {
      "factor": "diagnosis_to_treatment_lt_1_year",
      "points": 0,
      "present": false
    },
    {
      "factor": "hemoglobin_lt_lln",
      "points": 0,
      "present": false
    },
    {
      "factor": "corrected_calcium_gt_uln",
      "points": 0,
      "present": false
    },
    {
      "factor": "neutrophils_gt_uln",
      "points": 0,
      "present": false
    },
    {
      "factor": "platelets_gt_uln",
      "points": 0,
      "present": false
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Heng DY, Xie W, Regan MM, Warren MA, Golshayan AR, Sahi C, Eigl BJ, Ruether JD, Cheng T, North S, Venner P, Knox JJ, Chi KN, Kollmannsberger C, McDermott DF, Rini BI, Bukowski RM, Rha SY, Choueiri TK",
    "doi": "10.1200/JCO.2008.21.4809",
    "id": "heng-2009",
    "pmid": "19826129",
    "source": "J Clin Oncol. 2009;27(34):5794-5799",
    "title": "Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study"
  },
  "formula": "imdc",
  "formula_expression": "IMDC = kps_lt_80 1 + diagnosis_to_treatment_lt_1_year 1 + hemoglobin_lt_lln 1 + corrected_calcium_gt_uln 1 + neutrophils_gt_uln 1 + platelets_gt_uln 1; Heng 2009; max 6; favorable 0, intermediate 1-2, poor ≥3",
  "max_score": 6,
  "score": 0,
  "imdc_band": "favorable"
}
```

## Errors

- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [NLR](https://magentlab.com/docs/nlr) — Compute the Zahorec 2001 neutrophil-to-lymphocyte ratio from relative neutrophil and lymphocyte percents.
- [ANC](https://magentlab.com/docs/anc) — Compute absolute neutrophil count from WBC and neutrophil plus band percents, plus a Bodey 1966 granulocyte band.

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.