Hanninen et al developed a risk score for patients with metastatic renal cell carcinoma based on independent prognostic features identified on multivariate analysis. This was used to stratify patients by risk for evaluating therapy with interleukin-2. The authors are from Medizinische Hochschule-Hannover University Medical Center in Hannover, Germany.
Parameters:
(1) erythrocyte sedimentation rate (ESR)
(2) serum lactic dehydrogenase (LDH)
(3) absolute neutrophil count (ANC) per µL
(4) hemoglobin
(5) lung metastases (extrapulmonary lung metastases only)
(6) bone metastases
|
Parameter |
Finding |
Points |
|
ESR in mm first hour |
<= 70 mm |
0 |
|
|
> 70 mm |
2 |
|
serum LDH |
<= 280 IU/L |
0 |
|
|
> 280 IU/L |
2 |
|
absolute neutrophil count |
<= 6,000 per µL |
0 |
|
|
> 6,000 per µL |
1 |
|
hemoglobin |
>= 10 g/dL (100 g/L) |
0 |
|
|
< 10 g/dL |
1 |
|
lung metastases |
absent |
1 |
|
|
present |
0 |
|
bone metastases |
absent |
0 |
|
|
present |
1 |
where:
• I assume that the absolute neutrophil count and hemoglobin are the levels seen in the absence of acute infection or bleeding or recent transfusion.
total risk score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• Patient risk increased with increasing scores.
|
Total Score |
Risk Group |
2 Year Survival After Starting Therapy with Subcutaneous IL-2 |
|
0 |
low risk |
64% |
|
1 to 3 |
intermediate risk |
32% |
|
4 to 8 |
high risk |
< 10% |
Limitations:
• The method for determining serum LDH and its reference range was not stated. In Tietz's Clinical Guide to Laboratory Tests 280 IU/L is listed as the upper limit of the reference range of the pyruvate to lactate method at 30°C. The only way I can think of using LDH is using the upper limit of the normal reference range as the breakpoint.
Specialty: Hematology Oncology, Surgery, general, Nephrology
ICD-10: ,
