Frank et al developed a series of score to aid in surveillance of a patient with a clear cell carcinoma of the kidney after surgical resection. The thoracic score can help identify patients for whom surveillance should target an intra-thoracic recurrence. The authors are from the Mayo Clinic.
NOTE: This score and the immediately flanking ones share features with the SSIGN score and the score of Leibovich (above). All of the scores were developed at the Mayo Clinic.
Patient selection: clear cell carcinoma of the kidney, following partial or radical nephrectomy.
Parameters:
(1) pathologic T stage using the 2003 TNM standards
(2) pathologic N stage in regional lymph nodes using the 2003 TNM standards
(3) tumor diameter in cm
(4) nuclear grade
(5) histologic evidence of tumor necrosis
|
Histologic Features |
Nuclear Grade |
|
small round nuclei with inconspicuous nucleoli visible only at 400x magnification (high dry power) |
1 |
|
round to slightly irregular nuclei with mildly enlarged nucleoli visible at 200x magnification |
2 |
|
round to irregular nuclei with prominent nucleoli visible at 100x magnification |
3 |
|
enlarged, pleomorphic or giant cells present |
4 |
after the SSIGN (above) and Lohse et al (2002)
|
Parameter |
Finding |
Points |
|
pathologic T stage |
pT1a |
0 |
|
|
pT1b |
3 |
|
|
pT2 |
4 |
|
|
pT3a |
4 |
|
|
pT3b |
4 |
|
|
pT3c |
4 |
|
|
pT4 |
4 |
|
pathologic N stage |
pNx |
0 |
|
|
pN0 |
0 |
|
|
pN1 |
1 |
|
|
pN2 |
1 |
|
tumor diameter |
< 10 cm |
0 |
|
|
>= 10 cm |
1 |
|
nuclear grade |
grade 1 |
0 |
|
|
grade 2 |
0 |
|
|
grade 3 |
1 |
|
|
grade 4 |
2 |
|
tumor necrosis |
absent |
0 |
|
|
present |
1 |
thoracic score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 9
• The higher the score the greater the probability of an intra-thoracic tumor recurrence.
|
Thoracic Score |
Probability of 10 Year Survival Free of Intra-Abdominal Tumor Recurrence |
|
0 |
99% |
|
1-3 |
94% |
|
4 |
84% |
|
5 |
68% |
|
6 |
58% |
|
7 |
45% |
|
8 or 9 |
48% |
Specialty: Hematology Oncology, Surgery, general, Nephrology
ICD-10: ,
