Fong et al studied prognostic factors associated with survival following resection of hepatic metastases from colorectal carcinoma. They identified 2 factors that are contraindications to surgery and developed a clinical score for predicting survival.
Contraindications to hepatic resection due to poor prognosis:
(1) positive margins
(2) extrahepatic disease
Parameters used in score:
(1) lymph node involvement adjacent to primary tumor
(2) disease free interval between diagnosis of primary disease and metastatic disease
(3) number of hepatic tumors
(4) diameter of hepatic tumors
(5) CEA level in serum
|
Parameter |
Finding |
Points |
|
nodes positive in primary |
no |
0 |
|
|
yes |
1 |
|
disease free interval from primary to metastasis |
>= 12 months |
0 |
|
|
< 12 months |
1 |
|
number of hepatic tumors |
1 |
0 |
|
|
> 1 |
1 |
|
diameter of largest hepatic tumor |
<= 5 cm |
0 |
|
|
> 5 cm |
1 |
|
CEA serum level |
<= 200 ng/mL |
0 |
|
|
> 200 ng/mL |
1 |
clinical score =
= SUM(points for parameters present)
Interpretation:
• minimum score: 0
• maximum score: 5
• Patients without contraindications to surgery and with scores <= 2 can have a favorable outcome.
• Jarnagin et al found that the score could be used predict the likelihood of occult unresectable disease, with 12% of patients with scores <=2 being unresectable vs 42% of those with a score > 2. Laparoscopy can be used in patients with a score > 2, thereby avoiding laparotomy in this population.
|
Clinical Score |
5 Year Survival |
Median Survival |
|
0 |
60% |
74 months |
|
1 |
44% |
51 months |
|
2 |
40% |
47 months |
|
3 |
20% |
33 months |
|
4 |
25% |
20 months |
|
5 |
14% |
22 months |
Specialty: Hematology Oncology, Surgery, general
ICD-10: ,
