Petersen et al developed a cumulative prognostic index for evaluating patient's with Duke's B colon cancer. This can help identify those patients with a worse prognosis who may require more aggressive therapy. The authors are from Gloucestershire Royal Hospital in England.
Parameters:
(1) peritoneal involvement (with or without ulceration)
(2) venous invasion (extramural or submucosal)
(3) margin involvement (margin involved or inflamed)
(4) tumor perforation (perforation through the tumor)
|
Parameter |
Hazard Ratio |
95% CI |
p value |
|
peritoneal involvement |
2.88 |
1.69 – 4.90 |
0.0001 |
|
venous invasion |
2.70 |
1.61 – 4.53 |
0.0001 |
|
margin involvement |
2.61 |
1.42 – 4.79 |
0.002 |
|
tumor perforation |
9.43 |
3.28 – 27.05 |
0.0001 |
from Table 3, page 67
|
Parameter |
Finding |
Points |
|
peritoneal involvement |
absent |
0 |
|
|
present |
1 |
|
venous invasion |
absent |
0 |
|
|
present |
1 |
|
margin involvement |
absent |
0 |
|
|
present |
1 |
|
tumor perforation |
absent |
0 |
|
|
present |
2 |
cumulative prognostic index =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The higher the score, the worse the prognosis.
|
Score |
5 Year Survival (95% CI) |
|
0 |
94.2% (85 – 97.8) |
|
1 |
79.5% (69.9 – 86.3) |
|
2 |
54.3% (40.3 – 66.3) |
|
3 to 5 |
30.4% (7.8 – 57.4) |
Table 4, page 67
|
Score |
Risk Group |
5 Year Survival |
|
0 or 1 |
low risk |
85.7% |
|
2 to 5 |
high risk |
49.8% |
Limitations:
• As pointed out in the AJCC Manual, Duke's B and C stages are composites of better and worse prognostic groups (Duke's B as T3 N0 M0 and T4 N0 M0; Duke's C as N1 M0 and N2 M0). Use of the TNM classification scheme would obviate the need for this score.
• Duke's classification was based on rectal carcinoma. The modified Astler-Coller classification distinguishes B2 and B3 similar to the 2 TNM groups above.
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
ICD-10: ,
