Manchester Score For Small Cell Lung Cancer (SCLC)

Predicts 2-year survival rates for patients with small cell lung cancer (SCLC) based on Karnofsky score and lab tests.

In the text below the calculator there is more information on the score interpretation and on the original study.

The Manchester score uses the results from the Karnofsky performance status, the malignancy stage and four laboratory determinations (serum LDH, Na, alkaline phosphatase and bicarbonate) to prognosticate 2-year survival in small cell lung cancer.

This prediction model has been successfully used in clinical practice in the initiation of chemotherapy for patients with lung cancer.

Each of the six items is worded as to include by default the adverse outcome factoring (example Elevated serum LDH).

In case the item is deemed present, 1 point is awarded. For the Karnofsky performance status, all criteria below 60 (the criteria varies from 10 to 100) is given 1 point.

The table below introduces the Manchester score results and their correlated 2-year prognosis:

Manchester score Prognosis Two-year survival rate
≤1 Good 16.20%
2, 3 Medium 2.50%
≥4 Poor 0%


Elevated serum LDH


Serum Na <132 mmol/L


Elevated serum alkaline phosphatase >1.5x normal


Serum bicarbonate <24


Extensive stage disease


Karnofsky performance status

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Manchester score explained

This is a clinical prediction tool for patients with small cell lung cancer in intensive care units, used to determine when to administer chemotherapy.

It provides 2-year prognosis based on five patient parameters and the score from the Karnovsky performance status.

The table below describes the five parameters used:

Score items Description
Elevated serum LDH Overexpression of serum lactate dehydrogenase is characteristic to lung cancers.
Serum Na <132 mmol/L Hyponatremia is a negative prognostic factor in several cancers.
The overall 5-year survival rate in patients with SCLC varies:
- 74.8% for patients with high serum sodium concentration;
- 59.7% for patients with hyponatremia.
Elevated serum alkaline phosphatase >1.5x normal This is a group of enzymes that provides transport across cell membranes. Damage to tissue determines abnormal release of ALP in bloodstream. Also, there are particular forms of alkaline phosphatase generated by tumors.
Serum bicarbonate <24 The blood value of bicarbonate offers information on the state of acid-base physiology. It is found in an electrolyte panel.
Extensive stage disease Diagnosis of patients with SCLC is in the limited or extensive stage. Extensive stage indicates that either the other lung is also cancerous or that there are metastases in distant organs, such as liver or brain.

Score interpretation

Each of the 6 items in the score is awarded 1 point (if present for the first five or if Karnofsky below 60). Therefore, the total score varies between 0 and 6, where the higher the score, the worse the malignancy outcome prognosis.

The correlation between final score, prognosis and two-year survival is introduced in the table below:

Manchester score Prognosis Two-year survival rate
≤ 1 Good 16.20%
2, 3 Medium 2.50%
≥ 4 Poor 0%

About the study

The score is based on a study by Cerny et al. from 1987. A number of 61 pre-treatment variables were evaluated through multiple regression analysis for a cohort of 407 patients with small-cell lung cancer, in order to assess their prognostic value.

All 407 patients received some form of short-term intensive regimen, with cyclophosphamide, ifosfamide and etoposide or methotrexate and etoposide.

The most important prognostic factors were deemed the six that compose the score nowadays.

The results distinguish between three prognostic groups and define two-year prognosis. It was found that the score can facilitate comparison between studies and help with design of new cancer treatment for patients with SCLC.


Small cell lung cancer

SCLC, along with the non small cell lung cancer (NSCLC), are two types of primary lung cancer (they start in the bronchi).

The malignant cells tend to cluster, create large dimension tumors and are described as small cells with nucleus covering most of the surface.

15% of lung cancer cases are diagnosed with SCLC (with a higher incidence in men than women) and the main cause is smoking.

The characteristic symptoms include:

■ Bloody sputum;

■ Chest pain;

■ Shortness of breath;

■ Wheezing;

■ Fever;

■ Difficulty swallowing;

■ Weight loss;

■ General feeling of malaise.

Diagnosis is put based on clinical examination (i.e. stethoscope listening evidencing fluid or partial collapse of lung), chest x-ray, MRI, complete blood count and in some cases sputum test and thoracentesis.

Biopsy is also required and there are several types of procedure available:

■ Bronchoscopy;

■ CT scan directed needle biopsy;

■ Pleural or open lung biopsy.

SCLC management is through chemotherapy to try and prevent the cancer from spreading.

Small cell lung cancer is a highly lethal type of malignancy, with high degree of metastasis and with very low survival rates after 5 years. Radiation therapy can prolong life for six months to a year in most cases.

Prognosis in SCLC depends on how early the diagnosis is being put and how advanced the spread of cancer is. The table below presents the 5-year survival rate for SCLC, based on TNM (tumour, nodes, metastasized) staging:

Stage 5-year relative survival rate
I 31%
II 19%
III 8%
IV 2%

Original source

Cerny T, Blair V, Anderson H, Bramwell V, Thatcher N. Pretreatment prognostic factors and scoring system in 407 small-cell lung cancer patients. Int J Cancer. 1987; 39(2):146-9.


Kawahara M, Fukuoka M, Saijo N, Nishiwaki Y, Ikegami H, Tamura T, Shimoyama M, Suemasu K, Furuse K. Prognostic factors and prognostic staging system for small cell lung cancer. Jpn J Clin Oncol. 1997; 27(3):158-65.

Other references

1. Maestu I, Pastor M, Gómez-Codina J, Aparicio J, Oltra A, Herranz C, Montalar J, Munárriz B, Reynés G. Pretreatment prognostic factors for survival in small-cell lung cancer: a new prognostic index and validation of three known prognostic indices on 341 patients. Ann Oncol. 1997; 8(6):547-53.

2. Naito T, Tanaka F, Ono A, Yoneda K, Takahashi T, Murakami H, Nakamura Y, Tsuya A, Kenmotsu H, Shukuya T, Kaira K, Koh Y, Endo M, Hasegawa S, Yamamoto N. Prognostic impact of circulating tumor cells in patients with small cell lung cancer. J Thorac Oncol. 2012; 7(3):512-9.

Specialty: Oncology

System: Respiratory

Objective: Prognosis

Type: Score

No. Of Items: 6

Year Of Study: 1987

Article By: Denise Nedea

Published On: June 2, 2017

Last Checked: June 2, 2017

Next Review: June 2, 2023