Certain histologic features seen in squamous cell carcinoma of the esophagus can be used to derive a prognostic score which correlates with patient survival. The 2 parameters which correlate with patient outcome are the pattern of invasion and the nature of the inflammatory response.
|
Histologic Parameter |
Finding |
Points |
|
degree of keratinization |
highly keratinized (> 50% of the cells) |
1 |
|
|
moderately keratinized (20-50% of the cells) |
2 |
|
|
minimal keratinization (5-20% of the cells) |
3 |
|
|
no keratinization (0-5% of the cells) |
4 |
|
nuclear polymorphism |
none |
1 |
|
|
minimal |
2 |
|
|
moderate |
3 |
|
|
severe |
4 |
|
mitotic activity per high power field |
0-1 |
1 |
|
|
2-3 |
2 |
|
|
4-5 |
3 |
|
|
> 5 |
4 |
|
pattern of invasion |
pushing, well-delineated tumor margins |
1 |
|
|
infiltrating, solid cords and bands |
2 |
|
|
small groups of dissociated cells (N > 15) |
3 |
|
|
marked cellular dissociation |
4 |
|
inflammatory response |
marked |
1 |
|
|
moderate |
2 |
|
|
slight |
3 |
|
|
none |
4 |
total histologic score =
= (points for keratinization) + (points for nuclear polymorphism) + (points for mitotic activity) + (points for invasion pattern) + (points for inflammatory response)
prognostic score =
= (points for invasion pattern) + (points for inflammatory response)
Interpretation:
• minimal prognostic score: 2
• maximum prognostic score: 8
|
Prognostic Score |
Group |
2 year survival |
5 year survival |
|
2 or 3 |
1 |
72% |
54% |
|
4 |
2 |
45% |
28% |
|
5 or 6 |
3 |
35% |
10% |
|
7 or 8 |
4 |
18% |
5% |
(survival rates estimated from curves in Figure 1 page 925)
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
ICD-10: ,
