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Fong Clinical Risk Score for Colorectal Cancer Recurrence

Fong Clinical Risk Score for Colorectal Cancer Recurrence
Node-positive primary tumor
Disease-free interval from primary to metastases <12 months
More than 1 hepatic tumor
Largest hepatic tumor >5 cm
Preoperative CEA >200 ng/mL
Result0 points

0-2 points: lower clinical risk of recurrence after hepatic resection for colorectal liver metastases.

Fong score
0

When to use

  • Estimating recurrence risk and prognosis to guide surgical planning and perioperative chemotherapy discussions before/after resection of colorectal liver metastases.

Formula

One point each for: node-positive primary; disease-free interval <12 months; >1 hepatic tumor; largest tumor >5 cm; preoperative CEA >200 ng/mL. Range 0-5.

Pearls and pitfalls

  • Derived from >1000 hepatectomies at Memorial Sloan Kettering; a score of 0 does not preclude recurrence and a high score does not preclude long-term survival.
  • Predates routine use of modern systemic therapy and molecular markers (e.g. RAS/BRAF status), which also influence outcome.

References

  1. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer. Ann Surg. 1999;230(3):309-18.