# MSKCC Motzer score (1999) Motzer Status: LIVE Price: $0.005 USDC `GET /api/calc/motzer` HTML: https://magentlab.com/docs/motzer Markdown: https://magentlab.com/docs/motzer.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes 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. ## When to use When an agent needs the published Motzer 1999 MSKCC point total and risk group and must not invent an RCC diagnosis or treatment recommendation, must not use IMDC or Motzer 2002/2004, and must not assign KPS or assay labs. ## When not to use - Not a medical device and not an RCC diagnosis or treatment recommendation. magent does not examine the patient. - Not IMDC (Heng 2009). This tool does not include neutrophils or platelets. - Not Motzer 2002 or Motzer 2004. The fifth factor is absence of prior nephrectomy, not time from diagnosis to treatment. - magent does not assay LDH, hemoglobin, or calcium, apply ULN/LLN, or observe Karnofsky performance status. All five inputs are caller-assigned flags. - Motzer 1999 overall-survival figures are published interferon-era cohort results, not a predicted survival or a treatment choice. ## Formula ``` Motzer = kps_lt_80 1 + ldh_gt_1_5_uln 1 + hemoglobin_lt_lln 1 + corrected_calcium_gt_10 1 + no_prior_nephrectomy 1; Motzer 1999; max 5; favorable 0, intermediate 1-2, poor ≥3 ``` ## Citation [Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma](https://doi.org/10.1200/JCO.1999.17.8.2530) Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J. J Clin Oncol. 1999;17(8):2530-2540 DOI: [10.1200/JCO.1999.17.8.2530](https://doi.org/10.1200/JCO.1999.17.8.2530) ## 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, no_prior_nephrectomy=false` 1. All five caller-assigned flags false → 0 2. Score = 0 (max 5); motzer_band = favorable ### KPS <80, LDH >1.5×ULN, and hemoglobin 1.5 × institutional ULN as assigned by the caller (Motzer 1999). 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 (Motzer 1999). 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 (Motzer 1999 paper threshold, not institutional ULN). true scores 1. magent does not assay calcium. - `no_prior_nephrectomy` (boolean, required): Absence of prior nephrectomy as assigned by the caller (Motzer 1999). true scores 1. Not Motzer 2004 time from diagnosis to treatment. magent does not review operative history. ## 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/motzer` 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", "no_prior_nephrectomy": "false" }, { "corrected_calcium_gt_10": "false", "hemoglobin_lt_lln": "false", "kps_lt_80": "false", "ldh_gt_1_5_uln": "false", "no_prior_nephrectomy": "false" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/motzer Example 200: ```json { "count": 2, "path": "/api/calc/motzer", "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": "no_prior_nephrectomy", "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": "Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J.", "doi": "10.1200/JCO.1999.17.8.2530", "id": "motzer-1999", "pmid": "10561319", "source": "J Clin Oncol. 1999;17(8):2530-2540", "title": "Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma" }, "formula": "motzer", "formula_expression": "Motzer = kps_lt_80 1 + ldh_gt_1_5_uln 1 + hemoglobin_lt_lln 1 + corrected_calcium_gt_10 1 + no_prior_nephrectomy 1; Motzer 1999; max 5; favorable 0, intermediate 1-2, poor ≥3", "max_score": 5, "score": 0, "motzer_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": "no_prior_nephrectomy", "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": "Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J.", "doi": "10.1200/JCO.1999.17.8.2530", "id": "motzer-1999", "pmid": "10561319", "source": "J Clin Oncol. 1999;17(8):2530-2540", "title": "Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma" }, "formula": "motzer", "formula_expression": "Motzer = kps_lt_80 1 + ldh_gt_1_5_uln 1 + hemoglobin_lt_lln 1 + corrected_calcium_gt_10 1 + no_prior_nephrectomy 1; Motzer 1999; max 5; favorable 0, intermediate 1-2, poor ≥3", "max_score": 5, "score": 0, "motzer_band": "favorable" } ] } ``` ## Response fields - `formula` (string): motzer - `formula_expression` (string): Exact expression used - `score` (integer): Motzer 1999 points 0-5 - `max_score` (integer): Always 5 - `motzer_band` (string): favorable when score is 0, intermediate when 1–2, poor when 3–5 (Motzer 1999 MSKCC). Not an RCC diagnosis or treatment recommendation. Not IMDC. Not Motzer 2002/2004. Caller assigns KPS, LDH vs 1.5×ULN, hemoglobin vs LLN, corrected calcium vs 10 mg/dL, and prior nephrectomy. - `components` (array): Per-factor points - `citation` (object): Motzer 1999 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": "no_prior_nephrectomy", "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": "Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J.", "doi": "10.1200/JCO.1999.17.8.2530", "id": "motzer-1999", "pmid": "10561319", "source": "J Clin Oncol. 1999;17(8):2530-2540", "title": "Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma" }, "formula": "motzer", "formula_expression": "Motzer = kps_lt_80 1 + ldh_gt_1_5_uln 1 + hemoglobin_lt_lln 1 + corrected_calcium_gt_10 1 + no_prior_nephrectomy 1; Motzer 1999; max 5; favorable 0, intermediate 1-2, poor ≥3", "max_score": 5, "score": 0, "motzer_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 - [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. - 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.