GAME Score for Patients With Metastatic Colorectal Cancer
Surgical oncologists at the Johns Hopkins University School of Medicine may have developed an improved scoring system for predicting survival in people with colorectal cancers that have metastasized to the liver. According to the researchers, the system, called the Genetic and Morphological Evaluation (GAME) score, will provide the ability to more reliably predict outcomes, aid in setting realistic expectations for patients, and help physicians tailor treatment plans to maximize patient survival. Data on the scoring system were published by Margonis et al in the British Journal of Surgery.
The Johns Hopkins team had been scoring patients using the “gold standard” Fong system, developed in 1999, but many patient outcomes were inconsistent with their prognoses. So the team sought a new approach based on data from 502 patients with colorectal cancer and liver metastases who underwent liver tumor surgery at The Johns Hopkins Hospital from 2000 through 2015.
Statistical analysis identified six separate predictors of poor survival, and points were assigned to each based on their predictive power, as demonstrated by patient survival. The GAME score was calculated by allocating points to each patient according to the presence of these predictive factors: KRAS-mutated tumors (1 point), carcinoembryonic antigen level of 20 ng/mL or more (1 point), primary tumor lymph node metastasis (1 point), Tumor Burden Score between 3 and 8 (1 point) or 9 and over (2 points), and extrahepatic disease (2 points).
The researchers noted the GAME system includes traditional Fong indicators, such as the presence of tumor cells in the lymph nodes, but adds two new factors, including the presence of mutations in the KRAS gene. When compared, the GAME system outperformed the Fong system in a “modest but statistically significant way,” both on the Johns Hopkins patient data and another set of data from Memorial Sloan Kettering Cancer Center. The high-risk group in the Johns Hopkins cohort (GAME score ≥ 4 points) had a 5-year overall survival rate of 11%, compared with 73.4% for those in the low-risk group (score = 0–1 point). Importantly, in cohorts from both the Johns Hopkins and Sloan Kettering (747 patients), the discriminatory capacity of the GAME score was superior to that of the Fong score, they pointed out.
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