# Mekhail Motzer extension (2005) Mekhail Status: LIVE Price: $0.005 USDC `GET /api/calc/mekhail` HTML: https://magentlab.com/docs/mekhail Markdown: https://magentlab.com/docs/mekhail.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes 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. ## 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 [Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma](https://doi.org/10.1200/JCO.2005.05.179) Mekhail TM, Abou-Jawde RM, Boumerhi G, Malhi S, Wood L, Elson P, Bukowski R J Clin Oncol. 2005;23(4):832-841 DOI: [10.1200/JCO.2005.05.179](https://doi.org/10.1200/JCO.2005.05.179) ## Worked example ### All flags false Given: `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` 1. All six caller-assigned flags false → 0 2. Score = 0 (max 6); mekhail_band = favorable ### KPS <80, LDH >1.5×ULN, and hemoglobin 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. Method: `POST /api/calc/mekhail` 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_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" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/mekhail Example 200: ```json { "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 fields - `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 Frozen fixture. Not a live lookup. ```json { "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" } ``` ## Errors - HTTP 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. - 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 - [Motzer](https://magentlab.com/docs/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](https://magentlab.com/docs/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. - 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. 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.