Ueno et al evaluated patients with hepatic metastases from a colorectal cancer. They proposed a staging system ("H stage") which can help to guide management. The authors are from National Defense Medical College in Saitama, Japan.
Patient selection: hepatic metastases from a colorectal carcinoma
Parameters:
(1) tumor budding (as an indicator of tumor aggressiveness)
(2) time to diagnosis of liver metastases
(3) number of liver metastases
Parameter
Finding
Points
tumor budding
none or mild
0
moderate or severe
1
time to diagnosis
early (synchronous with primary or less than 1 year)
1
>= 1 year after colon cancer diagnosed
0
number of liver metastases
1 or 2
0
>= 3
1
total number of risk factors =
= SUM(points for all 3 parameters)
Tumor Budding
Time to Diagnosis
Number of Mets
H-Stage
0
0
0
A
0
1
0
A
0
0
1
A
1
0
0
B
0
1
1
B
1
1
1
C
Patterns not included in the Rule
Tumor Budding
Time to Diagnosis
Number of Mets
H-Stage
1
1
0
presumably B
1
0
1
presumably B
H Stage
5-year survival rate
Rate of Recurrence within 6 months
A
55%
7%
B
14%
30%
C
0%
44%
An elevated serum CEA at 1-3 months after hepatic resection is associated with a worse prognosis.
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