Fong Clinical Risk Score for Colorectal Cancer Recurrence
Predicts recurrence for colorectal cancer patients with liver metastasis after hepatic resection.
When to Use
Patients with hepatic metastases from colorectal cancer without evidence of extrahepatic disease.
Other Potential Use Cases
- Early operation runs the risk of missing smaller tumors when liver mets are small, while late operation runs the risk of progression in known metastases. The Fong Score allows risk stratification to help determine timing of surgical intervention as well as potential neoadjuvant/adjuvant therapy.
- The Fong Score can also help determine ideal candidates for novel imaging modalities for detecting occult disease (F-FDG whole-body positron emission tompography scanning (PET), radioimmunoimaging, etc.) (Schüssler-Fiorenza 2004)
- The Fong Clinical Risk Score for Colorectal Cancer Recurrence assigns colorectal cancer patients with liver metastasis a score of 0-5 based on 5 independent preoperative risk factors to estimate 5-year survival and median months of survival.
- Higher scores correlate with lower survival.
Points to Keep in Mind
- The scoring system is designed to aid in timing of surgical intervention and provide guidance in adjuvant therapy, NOT necessarily to determine surgical candidacy.
- Even in patients with high scores (4-5), there is clear survival benefit from surgical intervention.
- Positive surgical margin is a significant independent risk factor for survival but was not included in the scoring system due to its inability to use in preoperative patient selection.
- All patients with >1 tumor were given a score of 1. However, with advancement in hepatic surgery, resection of up to four hepatic metastases is common, and there is even data that patients with up to 7 liver lesions can have a significant survival benefit from surgical resection (Moroz 2002).
- Relative risks for the five criteria vary somewhat, but each is given a score of 1. Data shows that long-term outcome closely correlates with the current scoring system.
- Helps predict survival after resection of hepatic metastases of colorectal cancer.
- Aids in timing of surgical intervention.
- Provides guidance in adjuvant therapy.
- Aids in counseling patients to provide expected 5-year survival and median months of survival.
- Can aid in planning postoperative surveillance imaging.
- Can be used to compare patients from different institutions and studies.