Clemens et al developed a staging system for prostatic cancer based on clinical and anatomic factors. This can be used to indicate a patient's prognosis at the time of diagnosis and to compare outcomes of different interventions. The authors are from Yale University in New Haven, Connecticut.
Axes for score based on multivariate analysis:
(1) anatomic extent of tumor
(2) clinical manifestations related to cancer
(3) host factors
|
Parameter |
Finding |
Points |
|
anatomic extent of cancer |
intracapsular |
0 |
|
|
extracapsular without dissemination |
1 |
|
|
disseminated |
2 |
|
clinical manifestations |
none related to cancer |
0 |
|
|
urinary manifestations only |
2 |
|
|
metastatic or systemic manifestations |
4 |
|
host factors |
age < 70 and insignificant comorbidity |
0 |
|
|
age >= 70 and insignificant comorbidity |
2 |
|
|
any age and moderate comorbidity |
2 |
|
|
any age and severe comorbidity |
4 |
probability of surviving 5 years after time 0 =
= 1.04 – (0.13 * (anatomic points)) – (0.20 * ((clinical points)/2)) – (0.22 * ((host points)/2))
where:
• The equation is given on page 921. The equation used point assignments from a scoring table with the clinical and host factors scored 0, 1 or 2. To allow for easier use, these 2 axes were changed to 0, 2, or 4, as shown in the table above). Dividing by 2 gets these back to the original values.
clinical-anatomic score =
= SUM(points for the 3 axes)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the score, the more severe the disease.
|
C-A Score |
5 Year Survival Rate |
|
0 |
89% |
|
1 |
100% |
|
2 |
90% |
|
3 |
62% |
|
4 |
63% |
|
5 |
58% |
|
6 |
31% |
|
7 |
14% |
|
8 |
9% |
|
9 |
|
|
10 |
0% |
from Table 4, page 921
|
C-A Score |
Stage |
5 Year Survival Rate |
|
0 – 2 |
I |
91% |
|
3 – 5 |
II |
61% |
|
6 |
III |
31% |
|
>= 7 |
IV |
8% |
from Table 5, page 922
Limitations:
• The survival rate was based on patients admitted to the study between 1973 and 1976. Survival rates may have improved (at least for Stage I) due to better diagnosis and therapy.
• The score does not take into account other prognostic factors such as Gleason grading of the tumor.
Specialty: Hematology Oncology, Surgery, general, Urology
ICD-10: ,
