Clinical calculator summary
Original 2008 Royal Marsden Hospital phase-I prognostic score
Clinical calculator summary
Original 2008 Royal Marsden Hospital phase-I prognostic score
A three-factor additive baseline score using albumin, LDH relative to local ULN, and metastatic-site count.
Evidence-based context for fast calculator use
- Purpose:
- Reproduce the original RMH lower- versus higher-risk phase-I cohort grouping and show its historical cohort observations.
- Population:
- Adults with advanced solid tumors being evaluated for phase-I oncology trials at baseline.
- Factors:
- Albumin <35 g/L, LDH above local ULN, More than two metastatic sites
- Reference:
- Arkenau et al. Br J Cancer. 2008;98:1029-1033; prospective validation J Clin Oncol. 2009;27:2692-2696.
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RMH Score (Phase I Trials)
g/L
Clinical Context & Background
This calculator reproduces the original 2008 Royal Marsden Hospital (RMH) phase-I prognostic score. It assigns one point each for serum albumin below 35 g/L, LDH above the local laboratory upper limit of normal, and more than two metastatic sites. Raw baseline values are assessed without rounding.
The score was developed in a selected adult advanced-solid-tumor phase-I population and prospectively validated in 2009; participants were predominantly ECOG performance status 0-1. It is not a general survival calculator, a trial-eligibility rule, or a treatment recommendation, and it is not intended for routine therapy, phase II/III trials, surveillance, or post-treatment assessment.
Formula Logic
Original 2008 RMH score = 1 point each for albumin <35 g/L, LDH above the local laboratory upper limit of normal, and >2 metastatic sites.Reference Data
| Score | Original group | 2008 derivation median OS | 2009 prospective validation median OS |
|---|---|---|---|
| 0-1 | Lower-risk group | 74.1 weeks | 33.0 weeks |
| 2-3 | Higher-risk group | 24.9 weeks | 15.7 weeks |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- Use at baseline for adults with advanced solid tumors being evaluated for a phase-I oncology trial.
- Use the unrounded albumin, the reporting laboratory's LDH interpretation relative to its ULN, and the baseline metastatic-site count.
How To Interpret
- Scores 0-1 form the original lower-risk group; scores 2-3 form the higher-risk group.
- The displayed median survival values are historical observations from the 2008 derivation and 2009 prospective-validation cohorts, not individual predictions.
What To Do Next
- Integrate the score with protocol criteria, performance status, organ function, disease trajectory, comorbidity, patient goals, and specialist assessment.
- Do not use the score alone to determine trial eligibility or treatment.
Limitations
- Selected historical phase-I cohorts were predominantly ECOG 0-1 and may not represent contemporary early-phase practice.
- Not a general advanced-cancer survival calculator and not intended for routine therapy, phase II/III trials, surveillance, or post-treatment assessment.
- No source-backed upper limits are imposed on albumin or metastatic-site count.
Validated Population
Adults with advanced solid tumors treated or evaluated in the original Royal Marsden Hospital phase-I cohorts.
Equality example
Albumin 35 g/L, LDH at (not above) the local ULN, and exactly two metastatic sites each score zero.
Calculation verification history
Verified
Calculation verification history
Verified: Production browser revalidation
- Three source-backed cases passed through visible production controls at RMH scores 0, 1, and 3.
- The exact albumin/LDH/site rules and both prognostic groups rendered as expected.
- No unexpected N/A, literal undefined value, stale control, unsupported gauge, or browser-console error was observed.
Case-level evidence is retained in validation/browser-revalidation/rmh-clinical-trial-2026-08-03.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
- Overall browser status: failed-console. medium: Production emitted minified React error #418 during route loads/reloads used by this run.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/rmh-clinical-trial.json.
: Browser input adapter corrected and reverified
- Accepted finite number values already normalized by the shared calculator form while retaining strict malformed-input rejection.
- No equation, cutoff, unit, classification, or applicability rule changed; calculator-specific verification and the calculator-wide browser-input audit passed.
: Full validation test
- 256/256 independent model, exact-boundary, invalid-input, UI/reset, outcome, trace, wording, and immutability checks passed.
- No registered master panel calculates RMH; no panel receives inherited RMH verification.
: Calculation and input-contract correction
- Replaced three favorable pre-scored defaults with required raw albumin, explicit LDH status relative to the local ULN, and integer metastatic-site count; missing, extra, coercive, nonfinite, fractional, and out-of-domain values are rejected.
- Restored exact threshold equality handling, complete contribution trace, and source-correct 2008 and 2009 historical outcome rows without presenting the score as individualized survival, trial eligibility, or treatment guidance.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
Frequently Asked Questions
Does albumin exactly 35 g/L score a point?
No. The adverse criterion is strictly below 35 g/L.
How should LDH exactly at the laboratory ULN be entered?
Enter Normal / not above ULN. Only LDH above the local laboratory ULN scores a point.
Does the RMH score determine phase-I trial eligibility?
No. It is a historical prognostic grouping and must not replace protocol criteria or individualized specialist assessment.
Evidence-based oncology decision support. Verify with clinical guidelines.