Description

Shukla et al developed the Tata Memorial Hospital Scoring System (TMHSS) for evaluating a patient with gallbladder cancer. This can be used to help to guide management of the patient. The authors are from Tata Memorial Hospital in Mumbai, India.


Parameters:

(1) CA 19-9 concentration

(2) serum total bilirubin concentration

(3) CT scan findings

 

Parameter

Finding

Points

CA 19-9

<= 30 U/mL (normal)

1

 

30.1 to 90 U/mL (3x ULN)

2

 

90.1 to 450 U/mL (15x ULN)

3

 

> 450 U/mL

4

serum total bilirubin

<= 3 mg/dL

0

 

> 3 mg/dL

2

CT scan findings

normal

0

 

mass in the gallbladder

1

 

liver infiltration

2

 

intrahepatic biliary radicle dilatation or medially placed mass

3

 

metastatic disease

4

 

total score =

= SUM(points for all 3 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 10

• The higher the score the worse the prognosis.

 

Total Score

Resectable?

Management

<= 3

probably

surgery with staging laparotomy

4 to 6

possibly

surgery with staging and neoadjuvant options

>= 7

unlikely

palliative care with chemotherapy and stenting

 


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