Lai et al developed two histopathologic scores for separating patients with Stage IB or II cervical carcinoma into risk groups. This can help identify patients who may require more aggressive therapy. The authors are from Chang Gung University in Taoyuan, Taiwan.
Parameters:
(1) depth of stromal invasion
(2) stage
(3) tumor size in cm
(4) grade
(5) DNA index
|
Parameter for Prognostic Index |
Finding |
Points |
|
depth of stromal invasion |
<= 0.67 |
0 |
|
|
> 0.67 |
1 |
|
stage |
IB |
0 |
|
|
II |
1 |
|
tumor size in cm |
< 2 cm |
0 |
|
|
2 – 4 cm |
1 |
|
|
> 4 cm |
2 |
|
grade |
well-differentiated |
0 |
|
|
moderately differentiated |
1 |
|
|
poorly differentiated |
2 |
|
DNA index |
<= 1.3 |
0 |
|
|
> 1.3 |
1 |
prognostic index =
= (0.7064 * (points for depth of stromal invasion)) + (0.6087 * (points for stage)) + (0.3312 * (points for tumor size)) + (0.2918 * (points for tumor grade)) + (0.3104 * (points for DNA index))
|
Parameter for Prognostic Score |
Finding |
Points |
|
depth of stromal invasion |
<= 0.67 |
0 |
|
|
> 0.67 |
7 |
|
stage |
IB |
0 |
|
|
II |
6 |
|
tumor size in cm |
< 2 cm |
0 |
|
|
2 – 4 cm |
3 |
|
|
> 4 cm |
6 |
|
grade |
well-differentiated |
0 |
|
|
moderately differentiated |
3 |
|
|
poorly differentiated |
6 |
|
DNA index |
<= 1.3 |
0 |
|
|
> 1.3 |
3 |
prognostic score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum prognostic index: 0
• maximum prognostic index: 2.8715
• minimum prognostic score: 0
• maximum prognostic score: 28
|
Prognostic Index |
Prognostic Score |
Risk Group |
Relative Risk |
|
<= 0.3312 |
<= 3 |
low |
1.0 – 1.3926 |
|
0.3313 – 2.200 |
4 – 21 |
intermediate |
1.3927 – 9.0258 |
|
>= 2.2201 |
>= 22 |
high |
> 9.0259 |
from Table 4, page 1541
where:
• The range for prognostic score of the intermediate risk group is 6-21 in Table 4, but scores of 4 or 5 are possible.
|
Risk Group |
Probability of Recurrence Free Survival at 8 Years |
Probability of Overall 10 year Survival |
|
low |
94% |
87% |
|
intermediate |
77% |
70% |
|
high |
58% |
53% |
from Figure 1, page 1542
Additional risk factors associated with poor prognosis:
(1) lymph node metastases (this would make the tumor Stage IIIB)
(2) positive vaginal margin in resection specimen
(3) parametrial extension
Specialty: Hematology Oncology, Surgery, general, Obstetrics & Gynecology
ICD-10: ,
