{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:16:22Z","timestamp":1788171382225,"version":"build-2803163510"},"reference-count":25,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: AnemiaScore is an investigator-developed, deterministic, rule-based clinical decision-support framework for cancer-related anemia. This initial proof-of-concept study evaluated agreement with recorded local oncologist decisions, used as a clinical reference comparator rather than an independent standard. Methods: This single-center retrospective study analyzed 180 directly comparable A\u2013C cases in the primary three-category analysis. An exploratory full-cohort analysis included 188 eligible cases and descriptively incorporated Category D decisions arising either from the five-input laboratory core or from clinical factors outside that core. Results: In the primary cohort, overall percent agreement was 77.8% (140\/180; 95% CI, 71.2\u201383.2%), Cohen\u2019s \u03ba was 0.637 (95% bootstrap CI, 0.537\u20130.731), and Gwet\u2019s AC1 was 0.680 (95% bootstrap CI, 0.588\u20130.767). Among eight recorded clinician-override decisions, four met the laboratory-based R0 criterion, two were classified as Category D only through the external clinical-override classification, and two were not captured. The exploratory four-category agreement was 77.7% (146\/188; 95% CI, 71.2\u201383.0%). Conclusions: AnemiaScore reproduced a substantial proportion of local decision patterns, but concordance does not establish therapeutic appropriateness, clinical efficacy, safety, or superiority. Prospective multicenter validation with independent review and clinical and patient-reported outcomes is required before routine use.<\/jats:p>","DOI":"10.3390\/diagnostics16172796","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:21:19Z","timestamp":1788168079000},"page":"2796","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["AnemiaScore: An Investigator-Developed Rule-Based Clinical Decision-Support Framework for Cancer-Related Anemia\u2014A Single-Center Retrospective Proof-of-Concept Concordance Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Antonio","family":"Macci\u00f2","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology and Gynecological Oncology, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. Ricchi 1, 09121 Cagliari, Italy"},{"name":"Department of Oncological Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. Ricchi 1, 09121 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Gianuario","family":"Sanna","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Gynecological Oncology, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. Ricchi 1, 09121 Cagliari, Italy"},{"name":"Department of Oncological Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. Ricchi 1, 09121 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4731-8230","authenticated-orcid":false,"given":"Manuela","family":"Neri","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Gynecological Oncology, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. Ricchi 1, 09121 Cagliari, Italy"},{"name":"Department of Oncological Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. 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