Tan et al developed a clinical prognostic model for predicting survival in patients with hepatocellular carcinoma. The data elements are relatively simple, making the model applicable for developing countries. The authors are from Singapore General Hospital and the National Cancer Center in Singapore.
Parameters:
(1) ascites
(2) Zubrod performance score (ECOG performance score)
(3) serum alpha feta-protein (AFP) concentration
|
Parameter |
Finding |
Points |
|
ascites |
absent |
0 |
|
|
present |
1 |
|
|
unknown |
1 |
|
Zubrod performance |
0 (asymptomatic with normal activities) |
0 |
|
|
1 (symptoms but able to do usual activities) |
1 |
|
|
2 (out of bed more than 50% of the time) |
2 |
|
|
3 (in bed more than 50% of the time and needs some nursing care) |
2 |
|
|
4 (bedridden, dependent) |
2 |
|
|
unknown |
2 |
|
serum AFP |
0 - 499 µg/L |
0 |
|
|
500 - 4,999 µg/L |
1 |
|
|
5,000 - 49,999 µg/L |
2 |
|
|
>= 50,000 µg/L |
3 |
|
|
unknown |
3 |
from Table 4, page 2296
simple survival score =
= (2 * (points for ascites)) + (points for Zubrod performance) + (points for serum AFP)
where:
• This equation could be simplified further by making the points for ascites equal to 0 and 2.
Interpretation:
• minimum score: 0
• maximum score: 7
• The higher the score the worse the prognosis.
|
Survival Score |
Risk Group |
6 Month Survival Rate |
2 Year Survival Rate |
|
0 to 2 |
low |
34-43% |
8-12% |
|
3 or 4 |
intermediate |
15-22% |
2-5% |
|
5 to 7 |
high |
3-5% |
0-1% |
from Table 5 and Figures 1 and 2, page 2297
Limitations:
• The method for AFP is given (Axsym, Abbott Laboratories) but the normal reference is not stated, which limits transportability. It appears as if the normal range for adults is < 15 ng/mL, with values up to 200 ng/mL seen in some nonmalignant disorders.
• Scoring a patient with unknown data seems to me to be a poor practice.
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
ICD-10: ,
