Multinational association for supportive care in cancer (MASCC) versus clinical index of stable febrile neutropenia (CISNE): evaluation of predictive performance and clinical utility in patients with febrile neutropenia

Abstract

Abstract Objectives Febrile neutropenia is a life-threatening complication of chemotherapy, requiring prompt risk stratification to guide initial management decisions. While the Multinational Association for Supportive Care in Cancer (MASCC) score has long been used to identify low-risk patients, the Clinical Index of Stable Febrile Neutropenia (CISNE) was developed more recently to refine prognostication among apparently stable individuals. However, there remains no consensus on which score performs better in real-world emergency settings. Methods This retrospective, two-center study included adult patients diagnosed with FN who presented to the emergency departments of two tertiary hospitals between January 2022 and December 2024. Patients were categorized according to MASCC and CISNE scores based on clinical and laboratory parameters at admission. The primary outcome was defined as a composite of unfavorable in-hospital events, including hypotension, respiratory failure, ICU admission, major bleeding, organ dysfunction, or death. Discriminative ability was evaluated using ROC analysis and AUC comparison, with additional assessment via Net Reclassification Index (NRI) and Decision Curve Analysis (DCA). Results A total of 528 patients were included; 137 (25.9%) experienced adverse outcomes. MASCC score demonstrated higher sensitivity (78.8%) compared to CISNE (50.4%), while CISNE had higher specificity (88.2% vs. 75.7%). The AUC for MASCC was 0.838 and for CISNE 0.814; the difference was not statistically significant (p = 0.357). However, NRI analysis favored MASCC, indicating more accurate risk classification. DCA further demonstrated superior net clinical benefit of MASCC across relevant probability thresholds. Conclusions In the acute care setting, the MASCC score showed relatively higher sensitivity and clinical net benefit, supporting its potential value as a practical tool for early risk stratification in patients presenting with febrile neutropenia.

Keywords

• Febrile neutropenia
• MASCC score
• CISNE score
• Risk stratification
• Emergency department
• Adverse outcomes