Cady et al developed prognostic scores for predicting disease free survival in patients with colon cancer metastatic to the liver. This can help evaluate patients prior to surgical resection of metastatic nodules. The authors are from New England Deaconess Hospital, Harvard Medical School and the University of Southern Maine.
Basic protocol:
(1) default probability of 5 year disease free survival is 18%
(2) this is increased or decreased based on positive and negative prognostic factors
Prognostic scores:
(1) preoperative: based on number of metastatic nodules and the serum CEA level
(2) post-operative: based on resection margin, serum CEA and specimen weight
|
Preoperative Prediction |
Finding |
Percentage |
|
number of metastatic nodules |
1 |
+ 9% |
|
|
2 |
+ 9% |
|
|
>= 3 |
- 9% |
|
preoperative CEA antigen |
< 5 ng/mL |
+ 15% |
|
|
5 – 199 ng/mL |
0 % |
|
|
>= 200 ng/mL |
- 15% |
preoperative predicted probability of 5 year disease free survival =
= 18% + (percentage for number of nodules) + (percentage for CEA)
|
Postoperative Prediction |
Finding |
Percentage |
|
surgical resection margins |
negative (>= 1 cm) |
+ 30% |
|
|
close (< 1 cm but > 0) |
- 5% |
|
|
positive |
- 25% |
|
CEA antigen |
< 5 ng/mL |
+ 4% |
|
|
5 – 199 ng/mL |
- 2% |
|
|
>= 200 ng/mL |
- 2% |
|
resected specimen weight |
< 1,000 grams |
+ 5% |
|
|
>= 1,000 grams |
- 5% |
postoperative predicted probability of 5 year disease free survival =
= 18% + (percentage for margins) + (percentage for CEA) + (percentage for resected specimen weight)
Limitations:
• As therapy improves, the survivals are likely to get better over time.
•The presence and extent of other metastatic foci would reduce survival.
• I could not find what the normal reference range for CEA was. According to Tietz's Clinical Guide to Laboratory Tests, a nonsmoker should have a serum level < 5 ng/mL, while smokers can have slightly higher values.
Specialty: Hematology Oncology, Surgery, general
ICD-10: ,
