Prognostic Factors of Bacci et al for a Patient with Nonmetastatic Ewing Sarcoma of Bone Treated by Surgery and Adjuvant Chemotherapy

 

NOTE: The authors treated a total of 359 patients. 224 (62%) of the patients had surgery. 174 (49% of the total) had histologic examination for chemotherapy effect. The prognostic factors reported here refer to this subgroup. The authors also identified risk factors for the entire group, but this includes chemotherapeutic protocols that may not transport well.

 

Patient selection:

(1) nonmetastatic Ewing's sarcoma of bone

(2) treated with surgery and chemotherapy with or without radiation therapy

(3) had histologic examination after chemotherapy to document tumor response

 

Parameters:

(1) pretreatment fever (presence of temperature > 38°C lasting >= 14 days prior to starting therapy)

(2) pretreatment anemia (if < 12 years of age, a hemoglobin < 11.5 g/dL; if >= 12 and male a hemoglobin <= 13 g/dL; if >= 12 and female a hemoglobin <= 12 g/dL)

(3) pretreatment LDH level

(4) histologic response

Parameter	Finding	Points
fever	absent	0
	present	1
anemia	absent	0
	present	1
LDH level	normal	0
	elevated	1
histologic response	good	0
	poor (macroscopic foci of viable tumor cells)	1

 

where:

• The first 3 risk factors had relative risk ranging from 1.4 to 1.6, which are not very large.

• Histologic response had a relative risk about twice that of the other factors. A variation to consider is assigning this factor 2 points.

 

number of adverse prognostic factors associated with relapse =

= SUM(points for the 4 prognostic factors)

 

Interpretation:

• minimum number: 0

• maximum number: 4

• The risk for relapse increases as the number of adverse prognostic factors increases.