Frank et al developed a series of score to aid in surveillance of a patient with a clear cell carcinoma of the kidney after surgical resection. The bone score can help identify patients for whom surveillance should target bone metastases. The authors are from the Mayo Clinic.
NOTE: This score and the immediately previous two share features with the SSIGN score and the score of Leibovich (above). All of the scores were developed at the Mayo Clinic.
Patient selection: clear cell carcinoma of the kidney, following partial or radical nephrectomy.
Parameters:
(1) pathologic T stage using the 2003 TNM standards
(2) pathologic N stage in regional lymph nodes using the 2003 TNM standards
(3) nuclear grade
(4) histologic evidence of tumor necrosis
|
Histologic Features |
Nuclear Grade |
|
small round nuclei with inconspicuous nucleoli visible only at 400x magnification (high dry power) |
1 |
|
round to slightly irregular nuclei with mildly enlarged nucleoli visible at 200x magnification |
2 |
|
round to irregular nuclei with prominent nucleoli visible at 100x magnification |
3 |
|
enlarged, pleomorphic or giant cells present |
4 |
after the SSIGN (above) and Lohse et al (2002)
|
Parameter |
Finding |
Points |
|
pathologic T stage |
pT1a |
0 |
|
|
pT1b |
2 |
|
|
pT2 |
4 |
|
|
pT3a |
4 |
|
|
pT3b |
4 |
|
|
pT3c |
4 |
|
|
pT4 |
4 |
|
pathologic N stage |
pNx |
0 |
|
|
pN0 |
0 |
|
|
pN1 |
3 |
|
|
pN2 |
3 |
|
nuclear grade |
grade 1 |
0 |
|
|
grade 2 |
0 |
|
|
grade 3 |
1 |
|
|
grade 4 |
3 |
|
tumor necrosis |
absent |
0 |
|
|
present |
1 |
bone score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 11
• The higher the score the greater the probability of an intra-thoracic tumor recurrence.
|
Thoracic Score |
Probability of 10 Year Survival Free of Intra-Abdominal Tumor Recurrence |
|
0 or 1 |
99% |
|
2 or 3 |
95% |
|
4 |
88% |
|
5 |
84% |
|
6 |
81% |
|
7 or greater |
65% |
Specialty: Hematology Oncology, Surgery, general, Nephrology
ICD-10: ,
