Pomerance developed a prognostic index for carcinoma of the urinary bladder. This can help identify patients who may benefit from more aggressive or novel therapy. The author is from the Royal Marsden Hospital in London.
Parameters:
(1) depth of invasion
(2) tumor type
(3) mitotic activity
(4) lymphovascular spread
(5) metastases to lymph nodes
(6) cellular reaction along the invading edge
(7) density of the plasma cell infiltrate around the invading edge
|
Parameter |
Finding |
Points |
|
depth of invasion |
none (in situ) |
0 |
|
|
confined to mucosa |
1 |
|
|
into the superficial muscle |
1 |
|
|
into the deep muscle |
2 |
|
|
into the perivesical fat |
3 |
|
tumor type |
papillary |
0 |
|
|
mixed papillary and solid |
1 |
|
|
solid |
2 |
|
|
undifferentiated |
2 |
|
mitotic activity |
low |
0 |
|
|
high (marked) |
1 |
|
lymphovascular spread |
absent |
0 |
|
|
extensive |
1 |
|
metastases to lymph nodes |
absent |
0 |
|
|
present |
3 |
|
cellular reaction |
scanty |
1 |
|
|
patchy |
1 |
|
|
confluent |
0 |
|
|
moderate |
0 |
|
|
dense |
0 |
|
density of plasma cell infiltrate |
scanty |
1 |
|
|
moderate |
0 |
|
|
heavy |
0 |
where:
• The depth of invasion seems a bit ambiguous. I interpret superficial and deep muscle as both referring to the muscularis propria. I assume confined to the mucosa includes the lamina propria.
prognostic index =
= SUM(points for all 7 parameters)
Interpretation:
• minimum index: 0
• maximum index: 12
• The higher the index the worse the prognosis.
|
Total Index |
5 Year Survival (1972) |
|
0 to 4 |
63% |
|
5 to 9 |
14% |
|
10 to 12 |
0% |
Specialty: Hematology Oncology, Surgery, general, Urology
ICD-10: ,
