Davison et al proposed a grading scheme for mucinous neoplasms of the appendix. This can help to identify a patient who may benefit from a more aggressive or novel therapy. The authors are from the University of Pittsburgh.
Patient selection: mucinous tumor of the appendix
Parameters:
(1) destructive invasion
(2) cytologic features
(3) tumor cellularity
(4) angiolymphatic invasion
(5) perineural invasion
(6) signet ring cell component
|
Parameter |
Finding |
Points |
|
destructive invasion |
absent |
0 |
|
|
present |
1 |
|
cytologic features |
low to intermediate grade |
0 |
|
|
high grade |
1 |
|
tumor cellularity |
low to intermediate |
0 |
|
|
high |
1 |
|
angiolymphatic invasion |
absent |
0 |
|
|
present |
1 |
|
perineural invasion |
absent |
0 |
|
|
present |
1 |
|
signet ring cell component |
absent |
0 |
|
|
present |
1 |
number of adverse risk factors present other than signet ring cell component =
= SUM(points for first 5 parameters)
|
Signet Ring Cells |
Other Adverse Risk Factors |
Grade |
|
present |
NA |
G3 |
|
absent |
>= 1 |
G2 |
|
absent |
0 |
G1 |
|
Grade |
Relative Risk of Death |
50% Overall Survival (Kaplan-Meier) |
|
G1 |
1 |
12.5 years |
|
G2 |
2.7 |
6 years |
|
G3 |
5.1 |
4 years |
Other adverse prognostic factors:
(1) lymph node metastases
(2) distant metastases
(3) failure to use hyperthermic intraperitoneal chemotherapy when appropriate
(4) high frequency loss of heterozygosity (LOH) with fractional mutation rate >= 25%
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
