Garavello et al identified risk factors associated with distant metastases in patients with squamous cell carcinomas of the head and neck. These can help identify patients who may benefit from closer monitoring and more aggressive management. The authors are from San Gerado Hospital, Bassini Hospital and the University of Milano-Bicocca in Milan, Italy.
Parameters:
(1) age of the patient in years
(2) location of the primary tumor
(3) T stage
(4) N stage
(5) histologic grade
(6) locoregional control
|
Parameter |
Finding |
Relative Risk |
Points |
|
age of the patient |
>= 45 years |
1 |
0 |
|
|
< 45 years |
1.8 |
1 |
|
location of primary tumor |
oral cavity |
1 |
0 |
|
|
oropharynx |
5.8 |
3 |
|
|
hypopharynx |
13.7 |
7 |
|
|
larynx, supraglottis |
5.3 |
3 |
|
|
larynx, glottis |
6.9 |
3 |
|
T stage |
T1 |
1 |
0 |
|
|
T2 |
13.4 |
7 |
|
|
T3 |
15.9 |
8 |
|
|
T4 |
21.3 |
10 |
|
N stage |
N0 |
1 |
0 |
|
|
N1 |
6.8 |
3 |
|
|
N2 |
7.2 |
3 |
|
|
N3 |
10.7 |
5 |
|
histologic grade |
well-differentiated |
1 |
0 |
|
|
moderately differentiated |
2.1 |
1 |
|
|
poorly differentiated |
4.3 |
2 |
|
locoregional control |
yes |
1 |
0 |
|
|
no |
2.7 |
1 |
from Table 2, page 764
NOTE: The point scores are not part of the original paper. It was developed as an alternative to multiplying the relative risks. One point roughly corresponds to a relative risk of 2.
cumulative relative risks =
= PRODUCT(relative risks for all 6 parameters)
total risk score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum cumulative relative risks: 1
• maximum cumulative relative risks: 62,000 or so
• minimum risk score: 0
• maximum risk score: 26
|
Total Score |
Risk of Distant Metastases |
|
0 |
low |
|
1 or 2 |
low to moderate |
|
3 or 4 |
moderate |
|
5, 6 or 7 |
moderate to high |
|
8, 9 or 10 |
high |
|
>= 11 |
very high |
Specialty: Hematology Oncology, Surgery, general, Otolaryngology
