Nomogram of Modlin et al for Predicting Survival in a Patient with a Neuroendocrine Tumor of the Small Intestine

Description

Modlin et al proposed a score and a nomogram for predicting survival in a patient with a neuroendocrine tumor of the small intestine. This can help to identify a patient who may benefit from more aggressive management or trial of a novel therapy. The authors are from Yale University, Norwegian University of Science and Technology in Trodheim and the Universitatsmedizin Berlin.

Patient selection: neuroendocrine tumor of the small intestine

Parameters:

(1) age

(2) gender

(3) race

(4) symptoms at diagnosis

(5) urinary 5-HIAA

(6) serum chromogranin A

(7) liver function tests

(8) carcinoid heart disease

(9) tumor size in cm

(10) tumor stage

(11) tumor grade

(12) Ki-67 index

(13) liver metastases

(14) hepatic surgery to resect metastases

(15) somatostatin therapy

Age	Points
20 to 40 years	(0.004 * ((age)^2)) – (0.112 * (age)) + 2.17
40 to 75 years	(0.01206 * ((age)^2)) – (0.873 * (age)) + 19.78

Parameter	Finding	Points
gender	male	4
	female	0
race	white	0
	black	4
	other	8
symptoms at diagnosis	no	0
	yes	32
urinary 5-HIAA	normal	0
	elevated	4
serum chromogranin A	normal	0
	elevated	8
liver function tests	normal	0
	elevated
carcinoid heart disease	no	0
	yes	8
tumor size	< 2 cm	0
	2 to 2.5 cm	8
	> 2.5 cm	12
tumor stage	local	0
	regional spread	4
	distant metastases	12
tumor grade	Grade I	4
	Grade II	8
	Grade III	12
	Grade IV	16
Ki-67 index	< 5%	0
	5 to 10%	20
	> 10%	100
liver metastases	no	0
	yes	8
hepatic surgery	no	8
	yes	0
somatostatin therapy	no	12
	yes	0

total score =

= SUM(points for all of the parameters)

Interpretation:

• minimum score: 5.5 (age 20, Grade I)

• maximum score: > 200

• The higher the score the worse the prognosis.

Score	Percent with 10 Year Survival
< 10	> 76%
10 to 50	(-0.1 * (points)) + 77
50 to 100	(-0.01659 * ((points)^2)) + (1.513 * (points)) + 37.98
100 to 150	(-0.275 * (points)) + 51.5
> 150	< 8%

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Description

Specialty

ICD-10