Mekhail Motzer extension (2005)

Mekhail

Sum the Mekhail 2005 Motzer-extension factors (four Motzer 1999 factors that remained independent, plus prior radiotherapy and ≥2 metastatic sites) and return favorable (0–1), intermediate (2), or poor (≥3). Mekhail dropped Motzer’s no-prior-nephrectomy item.

LIVE $0.005 USDC GET /api/calc/mekhail

Markdown: /docs/mekhail.md · Canonical: https://magentlab.com/docs/mekhail

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

What it computes

When to use

When an agent needs the published Mekhail 2005 Motzer-extension point total and risk group and must not invent an RCC diagnosis or treatment recommendation, must not use Motzer 1999 bands or Motzer 2002 time-to-treatment, and must not assign KPS, assay LDH, hemoglobin, or calcium, image metastases, or review radiotherapy history.

When not to use

Not a medical device and not an RCC diagnosis or treatment recommendation. magent does not examine the patient.
Not Motzer 1999. Bands are Mekhail 2005: favorable 0 or 1, intermediate 2, poor more than 2 (≥3). Do not apply Motzer 1999 0 / 1–2 / ≥3.
Not Motzer 2002. This tool does not include time from diagnosis to treatment. Mekhail dropped Motzer’s no-prior-nephrectomy item.
Not IMDC (Heng 2009). This tool does not include neutrophils or platelets.
magent does not assay LDH, hemoglobin, or calcium, apply ULN/LLN, observe Karnofsky performance status, image metastases, or review radiotherapy history. All six inputs are caller-assigned flags. metastatic_sites_ge_2 is the paper’s 0–1 vs 2–3 site-count surrogate for individual hepatic, lung, and retroperitoneal nodal sites.

Formula

Mekhail = kps_lt_80 1 + ldh_gt_1_5_uln 1 + hemoglobin_lt_lln 1 + corrected_calcium_gt_10 1 + prior_radiotherapy 1 + metastatic_sites_ge_2 1; Mekhail 2005; max 6; favorable 0-1, intermediate 2, poor ≥3

Citation

Title: Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma
Authors: Mekhail TM, Abou-Jawde RM, Boumerhi G, Malhi S, Wood L, Elson P, Bukowski R
Source: J Clin Oncol. 2005;23(4):832-841
DOI: 10.1200/JCO.2005.05.179

Worked example

All flags false

Given: corrected_calcium_gt_10=falsehemoglobin_lt_lln=falsekps_lt_80=falseldh_gt_1_5_uln=falsemetastatic_sites_ge_2=falseprior_radiotherapy=false

All six caller-assigned flags false → 0
Score = 0 (max 6); mekhail_band = favorable

KPS <80, LDH >1.5×ULN, and hemoglobin <LLN

Given: corrected_calcium_gt_10=falsehemoglobin_lt_lln=truekps_lt_80=trueldh_gt_1_5_uln=truemetastatic_sites_ge_2=falseprior_radiotherapy=false

kps_lt_80 → 1; ldh_gt_1_5_uln → 1; hemoglobin_lt_lln → 1; remaining flags 0
Score = 3 (max 6); mekhail_band = poor (≥3)

Also searched as

Mekhail score
Mekhail Motzer extension
extended Motzer
Mekhail 2005
MSKCC Mekhail
metastatic RCC Mekhail
Motzer extension
Mekhail RCC

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/mekhail?kps_lt_80=false&ldh_gt_1_5_uln=false&hemoglobin_lt_lln=false&corrected_calcium_gt_10=false&prior_radiotherapy=false&metastatic_sites_ge_2=false

Full URL: https://api.magentlab.com/api/calc/mekhail?kps_lt_80=false&ldh_gt_1_5_uln=false&hemoglobin_lt_lln=false&corrected_calcium_gt_10=false&prior_radiotherapy=false&metastatic_sites_ge_2=false

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge.

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/mekhail?kps_lt_80=false&ldh_gt_1_5_uln=false&hemoglobin_lt_lln=false&corrected_calcium_gt_10=false&prior_radiotherapy=false&metastatic_sites_ge_2=false"

Parameters

Name	Type	Required	Description
`kps_lt_80`	boolean	required	Karnofsky performance status <80% as assigned by the caller (Mekhail 2005; Motzer 1999 factor that remained independent). true scores 1. magent does not observe KPS.
`ldh_gt_1_5_uln`	boolean	required	Serum LDH >1.5 × institutional ULN as assigned by the caller (Mekhail 2005; Motzer 1999 factor that remained independent). true scores 1. magent does not assay LDH or apply ULN.
`hemoglobin_lt_lln`	boolean	required	Hemoglobin below the institutional lower limit of normal as assigned by the caller (Mekhail 2005; Motzer 1999 factor that remained independent). true scores 1. magent does not assay hemoglobin or apply LLN.
`corrected_calcium_gt_10`	boolean	required	Corrected calcium >10 mg/dL as assigned by the caller (Mekhail 2005; Motzer 1999 paper threshold, not institutional ULN). true scores 1. magent does not assay calcium.
`prior_radiotherapy`	boolean	required	Prior radiotherapy as assigned by the caller (Mekhail 2005). true scores 1. magent does not review radiotherapy history.
`metastatic_sites_ge_2`	boolean	required	Two or more metastatic sites as assigned by the caller (Mekhail 2005: number of sites 0–1 vs 2–3 as surrogate for individual hepatic, lung, and retroperitoneal nodal sites). true scores 1. magent does not image metastases.

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.

POST /api/calc/mekhail Max 25 unit_amount + extra_item_amount * (n - 1) extra $0.002 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 (fixture)

{
  "items": [
    {
      "corrected_calcium_gt_10": "false",
      "hemoglobin_lt_lln": "false",
      "kps_lt_80": "false",
      "ldh_gt_1_5_uln": "false",
      "metastatic_sites_ge_2": "false",
      "prior_radiotherapy": "false"
    },
    {
      "corrected_calcium_gt_10": "false",
      "hemoglobin_lt_lln": "false",
      "kps_lt_80": "false",
      "ldh_gt_1_5_uln": "false",
      "metastatic_sites_ge_2": "false",
      "prior_radiotherapy": "false"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/mekhail",
  "items": [
    {
      "components": [
        {
          "factor": "kps_lt_80",
          "points": 0,
          "present": false
        },
        {
          "factor": "ldh_gt_1_5_uln",
          "points": 0,
          "present": false
        },
        {
          "factor": "hemoglobin_lt_lln",
          "points": 0,
          "present": false
        },
        {
          "factor": "corrected_calcium_gt_10",
          "points": 0,
          "present": false
        },
        {
          "factor": "prior_radiotherapy",
          "points": 0,
          "present": false
        },
        {
          "factor": "metastatic_sites_ge_2",
          "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": "Mekhail TM, Abou-Jawde RM, Boumerhi G, Malhi S, Wood L, Elson P, Bukowski R",
        "doi": "10.1200/JCO.2005.05.179",
        "id": "mekhail-2005",
        "pmid": "15681528",
        "source": "J Clin Oncol. 2005;23(4):832-841",
        "title": "Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma"
      },
      "formula": "mekhail",
      "formula_expression": "Mekhail = kps_lt_80 1 + ldh_gt_1_5_uln 1 + hemoglobin_lt_lln 1 + corrected_calcium_gt_10 1 + prior_radiotherapy 1 + metastatic_sites_ge_2 1; Mekhail 2005; max 6; favorable 0-1, intermediate 2, poor ≥3",
      "max_score": 6,
      "score": 0,
      "mekhail_band": "favorable"
    },
    {
      "components": [
        {
          "factor": "kps_lt_80",
          "points": 0,
          "present": false
        },
        {
          "factor": "ldh_gt_1_5_uln",
          "points": 0,
          "present": false
        },
        {
          "factor": "hemoglobin_lt_lln",
          "points": 0,
          "present": false
        },
        {
          "factor": "corrected_calcium_gt_10",
          "points": 0,
          "present": false
        },
        {
          "factor": "prior_radiotherapy",
          "points": 0,
          "present": false
        },
        {
          "factor": "metastatic_sites_ge_2",
          "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": "Mekhail TM, Abou-Jawde RM, Boumerhi G, Malhi S, Wood L, Elson P, Bukowski R",
        "doi": "10.1200/JCO.2005.05.179",
        "id": "mekhail-2005",
        "pmid": "15681528",
        "source": "J Clin Oncol. 2005;23(4):832-841",
        "title": "Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma"
      },
      "formula": "mekhail",
      "formula_expression": "Mekhail = kps_lt_80 1 + ldh_gt_1_5_uln 1 + hemoglobin_lt_lln 1 + corrected_calcium_gt_10 1 + prior_radiotherapy 1 + metastatic_sites_ge_2 1; Mekhail 2005; max 6; favorable 0-1, intermediate 2, poor ≥3",
      "max_score": 6,
      "score": 0,
      "mekhail_band": "favorable"
    }
  ]
}

Response

Field	Type	Description
`formula`	string	mekhail
`formula_expression`	string	Exact expression used
`score`	integer	Mekhail 2005 points 0-6
`max_score`	integer	Always 6
`mekhail_band`	string	favorable when score is 0 or 1, intermediate when 2, poor when 3–6 (Mekhail 2005). Not Motzer 1999 0 / 1–2 / ≥3. Not Motzer 2002 time-to-treatment. Not an RCC diagnosis or treatment recommendation. Not IMDC. Caller assigns KPS, LDH vs 1.5×ULN, hemoglobin vs LLN, corrected calcium vs 10 mg/dL, prior radiotherapy, and ≥2 metastatic sites.
`components`	array	Per-factor points
`citation`	object	Mekhail 2005 J Clin Oncol citation
`disclaimer`	string	Not-a-device notice

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup.

{
  "components": [
    {
      "factor": "kps_lt_80",
      "points": 0,
      "present": false
    },
    {
      "factor": "ldh_gt_1_5_uln",
      "points": 0,
      "present": false
    },
    {
      "factor": "hemoglobin_lt_lln",
      "points": 0,
      "present": false
    },
    {
      "factor": "corrected_calcium_gt_10",
      "points": 0,
      "present": false
    },
    {
      "factor": "prior_radiotherapy",
      "points": 0,
      "present": false
    },
    {
      "factor": "metastatic_sites_ge_2",
      "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": "Mekhail TM, Abou-Jawde RM, Boumerhi G, Malhi S, Wood L, Elson P, Bukowski R",
    "doi": "10.1200/JCO.2005.05.179",
    "id": "mekhail-2005",
    "pmid": "15681528",
    "source": "J Clin Oncol. 2005;23(4):832-841",
    "title": "Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma"
  },
  "formula": "mekhail",
  "formula_expression": "Mekhail = kps_lt_80 1 + ldh_gt_1_5_uln 1 + hemoglobin_lt_lln 1 + corrected_calcium_gt_10 1 + prior_radiotherapy 1 + metastatic_sites_ge_2 1; Mekhail 2005; max 6; favorable 0-1, intermediate 2, poor ≥3",
  "max_score": 6,
  "score": 0,
  "mekhail_band": "favorable"
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

HTTP	Code	When
400	`invalid_mekhail`	Mekhail Motzer-extension inputs must match Mekhail 2005 Motzer factors, prior radiotherapy, and metastatic-site count from that paper. Returned before settlement; you are not charged.
400	`invalid_items`	POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
400	`invalid_item_count`	items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
400	`invalid_item`	each items entry must be a JSON object Returned before settlement; you are not charged.

Related tools

Motzer — Sum the Motzer 1999 MSKCC adverse factors for advanced RCC and return favorable (0), intermediate (1–2), or poor (≥3). Motzer 1999 reported median survival of 20, 10, and 4 months in those interferon-era groups as published cohort results, not a predicted survival.
IMDC — 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.

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. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /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. HTTP 402 never includes the tool JSON.
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.