Grading and Prognostic System for Rectal Carcinoma of Jass et al

Description

Jass et al proposed a pathologic grading and prognostic scheme for rectal carcinoma. The prognostic scheme is based on both grading and staging parameters.

Study data: 447 patients with rectal adenocarcinoma in London (St. Mark's and St. Bartholomew's Hospitals). Data was analyzed using the Cox regression model.

Parameters for Grading:

(1) tubular configuration

(2) pattern of tumor growth

(3) lymphocytic infiltration

Parameters for Pathologic Prognostic Categories:

(1) lymphocytic infiltration (grading)

(2) lymph node involvement (staging)

(3) spread through the bowel wall (staging)

Grading

Parameter	Finding	Points
tubular configuration	regular	0
	irregular	2
	none	4
pattern of tumor growth	expanding	0
	infiltrating	2
lymphocytic infiltration	marked	0
	moderate	3
	little	6
	none	6

Table 3, page 452

grading score =

= SUM(points for the 3 parameters)

Interpretation:

• minimum grading score: 0

• maximum grading score: 12

Score	Grade	Corrected 5 Year Survival (%)
0	I	93%
1 - 4	II	70%
5 - 8	III	52%
9 - 12	IV	20%

Table 4, page 452

Pathologic Prognostic Scoring (Grade and Stage)

Parameter	Finding	Points
lymphocytic infiltration	marked	0
	moderate	3
	little	6
	none	6
lymph node involvement	0	0
	1 - 4	4
	>= 5	8
spread through the bowel wall	none	0
	slight	0
	moderate	3
	extensive	6

Table 6, page 455

pathologic prognostic score =

= SUM(points for the 3 parameters)

Interpretation

• minimum pathologic prognostic score: 0

• maximum pathologic prognostic score: 20

Score	Pathologic Prognostic Score	Corrected 5 Year Survival (%)
0	I	100%
1 - 6	II	88%
7 - 11	III	72%
12 - 16	IV	32%
17-20	V	6%

Table 7, page 455

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Description

Specialty

ICD-10