"The nomogram allows for a more individualized prediction of recurrence and is significantly more accurate than the current AJCC staging system, which assumes that all patients in any given stage have a similar outcome." -- Martin Weiser, Memorial Sloan-Kettering surgical oncologist |
To address this need, the new colorectal cancer nomogram is based on a database of 1,320 Memorial Sloan-Kettering patients with colorectal cancer that did not spread beyond the colon. The tool is designed to help patients and their physicians better understand long-term outcomes after colon cancer surgery. Clinical data used in the model include patient age, tumor location, the numbers of positive and negative lymph nodes, the presence of tumor cells in surrounding lymphatic, vascular, or neural structures, and the use of postoperative chemotherapy.
"The nomogram allows for a more individualized prediction of recurrence and is significantly more accurate than the current AJCC staging system, which assumes that all patients in any given stage have a similar outcome," notes Martin R. Weiser, a surgical oncologist at Memorial Sloan-Kettering and one of the colorectal nomogram's creators. "We hope this will enable physicians and patients to better understand the risk of recurrence, which is critical when deciding whether or not to undergo adjuvant, or postoperative, therapy."
Utilizing this information, the tool can be used, in consultation with a physician, to predict the probability of recurrence of colon cancer five to ten years following the surgical removal of all cancerous tissue. By identifying the patients who will be at high and low risk within any particular stage of colorectal cancer, the nomogram can provide guidance for individuals and their physicians planning their treatment.
Breast Nomograms
Women newly diagnosed with breast cancer are increasingly interested in information about their disease, including the likelihood of their breast cancer spreading to what are known as sentinel lymph nodes, as well as additional nonsentinel lymph nodes under the arm. A sentinel lymph node is the first lymph node to which cancer is likely to spread from a primary tumor, making its status an important prognostic factor in patients with invasive breast cancer. Helping patients and their physicians navigate their way through complex treatment decisions, the two-part breast cancer nomogram includes a Sentinel Lymph Nodes Metastasis tool and an Additional Nodal Metastasis tool.
Sentinel Lymph Nodes Metastasis
The Sentinel Lymph Nodes Metastasis tool helps physicians and patients to accurately predict the likelihood that the disease has spread beyond the original tumor to a sentinel lymph node. Using the nomogram, women with breast cancer enter answers to a series of questions, addressing factors including age, tumor type, and tumor size. The software program then calculates the probability that their cancer has spread to a sentinel node.
While the nomogram's creators maintain that most women with breast cancer should still have a sentinel node biopsy, they also note that this application could help physicians to select precisely those patients at very low risk for sentinel lymph node involvement who may have other health concerns, such as the elderly. These individuals could be spared a biopsy. Alternatively, the tool's authors note that results from the nomogram could encourage a physician to reconsider an initial decision to spare a patient a sentinel lymph node biopsy in the event that a higher than expected risk is identified.
Additional Nodal Metastasis
The standard of care for breast cancer patients whose primary breast cancer has spread to the sentinel lymph nodes includes complete dissection of the lymph nodes found in the armpit, which are known as axillary lymph nodes. Many doctors question the need for every patient with detectable sentinel lymph node metastases to undergo this procedure, particularly when the patient is perceived to have a low risk of nonsentinel lymph node spread. Accurate estimates of the likelihood of additional disease in the armpit can assist in decision making regarding further treatment.
As a result, the Additional Nodal Metastasis tool can be used by women with breast cancer and their physicians to calculate the likelihood that their breast cancer that has spread to the sentinel lymph nodes will also spread to additional lymph nodes under the arm.
"These nomograms provide, for the first time, an individualized risk estimate for a woman with breast cancer," notes one of the nomogram's authors, Memorial Sloan-Kettering breast surgeon Kimberly J. Van Zee. "Historically, for example, various risk factors have been known to be associated with an elevated risk of lymph node metastasis. But for an individual woman, it was not possible to look at several factors, combine them, and calculate a risk estimate specific to an individual."
Prostate Nomograms
Each man diagnosed with prostate cancer must choose which treatment plan -- watchful waiting, surgery, chemotherapy, radiation therapy, hormone therapy -- is most suited to his particular condition and circumstances. Memorial Sloan-Kettering's prostate nomograms help with this difficult choice.
A combination of disease factors -- including stage of the cancer, prostate specific antigen (PSA) level, biopsy pathology, prior use of hormone therapy, and radiation dosage -- has been incorporated into the four individual prostate nomograms: Pre-Treatment, Post-Radical Prostatectomy, Salvage Radiation Therapy, and Hormone Refractory.
Pre-Treatment
Designed to be used by patients who have biopsy-confirmed prostate cancer but have yet to be treated, the Pre-Treatment tool can predict a patient's probability of survival following the major primary treatments, which include radical prostatectomy (the surgical removal of the entire prostate), brachytherapy (a procedure in which radioactive seeds are placed in or near the tumor), and external beam radiation therapy (radiation therapy using high-energy rays).
Post-Radical Prostatectomy
For men who have already received a radical prostatectomy, the Post-Radical Prostatectomy tool can be used to predict a patient's probability of survival two, five, and seven years after the surgery.
Salvage Radiation Therapy
For men who have experienced a recurrence of their prostate cancer after being treated with a prostatectomy, the Salvage Radiation Therapy tool predicts treatment success six years after salvage radiation therapy (SRT), which uses high-dose radiation to treat the recurring cancer.
Hormone Refractory
For men whose prostate cancer has spread beyond the prostate or has recurred after treatment, hormonal therapy may reduce levels of testosterone, which, when present in high levels, can stimulate the growth of prostate cancer cells. The Hormone Refractory tool, designed to be used by people who have been treated either with prostatectomy or radiation therapy as a primary treatment, can predict one- and two-year survival after hormone refractory therapy.
The nomogram developers urge individuals considering use of any of these tools to do so only in close consultation with their physician.
