Fong Clinical Risk Score for Colorectal Cancer Recurrence
Predicts recurrence for colorectal cancer patients with liver metastasis after hepatic resection.
- Patients with Fong Score 0-2 are considered “low risk” and may proceed with surgical intervention.
- Patients with Fong Score 3-5 are considered “high risk” and may benefit from close surveillance if surgery is deemed unacceptably high risk, additional preoperative workup/treatment before surgery, or additional postoperative treatment.
From Khatri 2005:
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Conventional indications |
Modern aggressive approach |
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<4 metastases, unilobar disease |
No limits. Multiple/bilobar metastases acceptable, using neoadjuvant chemotherapy, staged resection, and resection/local ablative therapy. |
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Size <5 cm |
No limits. |
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No extrahepatic disease |
Pulmonary metastases can be resected. |
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Resection margin >1 cm |
Resection margin <1 cm managed with ablative treatment of narrow margin (cryosurgery or radiofrequency ablation). |
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Adequate remnant liver parenchyma |
Preoperative portal vein embolization to increase liver remnant volume. |
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Resection of all macroscopic disease |
NED can be achieved with combination of resection and local ablative therapy. |
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No metachronous liver metastases |
Synchronous and metachronous metastases acceptable. |
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Absence of vena cava and hepatic vein confluence invasion |
No limits. Caval/hepatic vein resection with reconstruction can be performed. |
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Absence of hepatic pedicle lymph node metastases |
In absence of celiac axis metastases, hepatic pedicle lymph node metastases may be resected for improved 3-year survival. |
- About 1/3 of 5-year survivors ultimately die from their disease, and it is not yet certain whether the Fong Score accurately predicts survival beyond five years. Therefore, continued surveillance is currently recommended for patients after five years even if they are considered “low risk.”
- With continued advances in surgery, re-resection of hepatic metastases is proven to be still low risk while conferring a survival benefit, and therefore should be considered.