Preoperative Prognostic Factors After Liver Resection for Non‐Colorectal, Non‐Neuroendocrine Liver Metastases and Validation of the Adam Score in an Asian Population

Sim, D P Y; Goh, Brian K. P.; Lee, Ser‐Yee; Chan, Chung‐Yip; Tan, Iain Beehuat; Cheow, Peng‐Chung; Jeyaraj, Prema Raj; Chow, Pierce K. H.; Ooi, London L P J; Chung, Alexander

doi:10.1007/s00268-017-4208-z

Cited by 12 publications

(15 citation statements)

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“… 10 In the study by Sim et al 5 , the site of the primary tumor did not have any impact on overall or recurrence‐free survival. However, in terms of histology, patients with adenocarcinoma fared better when compared to those of other histologies ( p = .016 recurrence‐free interval, p = .036 OS) 5 . In our study, the median overall survival was highest for breast cancer (93 months) followed by GIST (56 months).…”

Section: Discussionmentioning

confidence: 90%

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Is resection for noncolorectal, nonneuroendocrine liver metastases justified?

Patkar

Niyogi

Parray

et al. 2021

Journal of Surgical Oncology

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Introduction The role of hepatectomy in non‐colorectal, nonneuroendocrine liver metastasis (NCNN) is not clearly defined. This study represents a step towards surgical frame‐shift as an integral part of treatment pathway in these heterogeneous, arbitrarily treated tumors. It aims to provide answers regarding favorable tumor types and patient profiles for which liver metastasectomy would prove beneficial. Materials and Methods Retrospective analysis of prospectively maintained database of hepatectomy in NCNN liver metastasis. Results A total of 50 patients out of 516 patients underwent liver resection during this period. In 27 patients, the liver metastases presented synchronously whereas the other 23 were metachronous. Median disease‐free interval (DFI) was 36 months. Gastrointestinal stromal tumors (GIST) were the most common type of primary malignancy (15, 30%). In 41 patients, the liver was the only site of metastases. At a median follow‐up of 32.5 months, 24 patients developed recurrences. Five‐year overall (OS) and disease‐free survival (DFS) for the entire cohort was 60% and 32%, respectively. Median OS was highest in the breast (93 months) followed by GIST (56 months). Patients with longer DFI showed improved OS. (p = .04). Conclusion Liver resection for NCNN metastases is safe and feasible in selected patients with good survival outcomes. Longer DFI correlates with better survival.

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Section: Discussionmentioning

confidence: 90%

“…A 5‐year survival of 30% for patients with score 0–3 is estimated which decreases to less than 10% in patients with score of 6 or more. 5,7 …”

Section: Methodsmentioning

confidence: 99%

Is resection for noncolorectal, nonneuroendocrine liver metastases justified?

Patkar

Niyogi

Parray

et al. 2021

Journal of Surgical Oncology

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“…Different predictive and prognostic factors, mainly related to surrogate markers of primary tumor aggressiveness, including the rate of progression and the extent of metastatic disease, have been proposed [2,3,5]. However, apart from the fact that these factors and risk models have been inconsistently validated in external series [2,3,[6][7][8][9], their accuracy for preoperatively distinguishing the individual patients who will or will not benefit from surgery remains undetermined. In fact, this question regarding the benefit of surgery in these oncological patients is complex as benefits may range from improved quality of life and avoidance or delay of several lines of chemotherapy to prolonged survival and cure.…”

Section: Introductionmentioning

confidence: 99%

The lack of selection criteria for surgery in patients with non-colorectal non-neuroendocrine liver metastases

et al. 2020

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Background: The benefit of surgery in patients with non-colorectal non-neuroendocrine liver metastases (NCRN NELM) remains controversial. At the population level, several statistical prognostic factors and scores have been proposed but inconsistently verified. At the patient level, no selection criteria have been demonstrated to guide individual therapeutic decision making. We aimed to evaluate potential individual selection criteria to predict the benefit of surgery in patients undergoing treatment for NCRNNELM. Methods: Data for 114 patients undergoing surgery for NCRNNELM were reviewed. In this population, we identified an early relapse group (ER), defined as patients with unresectable recurrence < 1 year postoperatively who did not benefit from surgery (N = 28), and a long-term survival group (LTS), defined as patients who were recurrence-free ≥ 5 years postoperatively and benefited from surgery (N = 20). Clinicopathologic parameters, the Association Française de Chirurgie (AFC) score, and a modified 4-point Clinical Risk Score (mCRS) (excluding CEA level) were analyzed and compared between LTS and ER groups. Results: The majority of patients were female and a majority had an ASA score ≤ 2 at the time of liver surgery. The median age was 55 years. Almost half of the patients (46%) presented with a single-liver metastasis. Intermediateand low-risk AFC scores represented 40% and 60% of the population, respectively. Five-and 10-year overall survival (OS) and disease-free survival (DFS) rates were 56% and 27%, and 30% and 12%, respectively. Negative prognostic factors were the size of liver metastases > 50 mm and delay between primary and NCRNNELM <24 months for OS and DFS, respectively. AFC score was not prognostic while high-risk mCRS (scores 3-4) was predictive for the poorer OS. The clinicopathologic parameters were similar in the ER and LTS groups, except the presence of N+ primary tumor, and the size of liver metastases was significantly higher in the ER group. Conclusion: In patients with resectable NCRNNELM, no predictive factors or scores were found to accurately preoperatively differentiate individual cases in whom surgery would be futile from those in whom surgery could be associated with a significant oncological benefit.

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“…Different predictive and prognostic factors, mainly related to surrogate markers of primary tumor aggressiveness, including the rate of progression and the extent of metastatic disease, have been proposed [2,3,5] . However, apart from the fact that these factors and risk models have been inconsistently validated in external series [2,3,[6][7][8][9] , their accuracy for preoperatively distinguishing the individual patients who will or will not bene t from surgery remains undetermined. In fact, this question regarding the bene t of surgery in these oncological patients is complex as bene ts may range from improved quality of life and avoidance or delay of several lines of chemotherapy, to prolonged survival and cure.…”

Section: Introductionmentioning

confidence: 99%

The lack of selection criteria for surgery in patients with non-colorectal non-neuroendocrine liver metastases

Bohlok

Lucidi

Bouazza

et al. 2020

Preprint

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Background: The benefit of surgery in patients with non-colorectal non-neuroendocrine liver metastases (NCRNNELM) remains controversial. At the population level, several statistical prognostic factors and scores have been proposed but inconsistently verified. At the patient level, no selection criteria have been demonstrated to guide individual therapeutic decision making. We aimed to evaluate potential individual selection criteria to predict the benefit of surgery in patients undergoing treatment for NCRNNELM.Methods: Data for 114 patients undergoing surgery for NCRNNELM were reviewed. In this population, we identified an early relapse group (ER), defined as patients with unresectable recurrence <1 year postoperatively who did not benefit from surgery (N=28), and a long-term survival group (LTS), defined as patients who were recurrence-free ≥5-years postoperatively and benefited from surgery (N=20). Clinicopathologic parameters, the Association Française de Chirurgie (AFC) score, and a modified 4-point Clinical Risk Score (mCRS) (excluding CEA level) were analyzed and compared between LTS and ER groups.Results: The majority of patients were female and a majority had an ASA score ≤2 at the time of liver surgery. Median age was 55 years. Almost half of the patients (46%) presented with a single liver metastasis. Intermediate- and low-risk AFC scores represented 40% and 60% of the population, respectively. Five- and ten-year overall survival (OS) and disease-free survival (DFS) rates were 56% and 27%, and 30% and 12%, respectively. Negative prognostic factors were size of liver metastases >50 mm and delay between primary and NCRNNELM <24 months for OS and DFS, respectively. AFC score was not prognostic while high-risk mCRS (score 3-4) was predictive for poorer OS. The clinicopathologic parameters were similar in the ER and LTS groups, except the presence of N+ primary tumor and the size of liver metastases were significantly higher in the ER group. Conclusion: In patients with resectable NCRNNELM, no predictive factors or scores were found to accurately preoperatively differentiate individual cases in whom surgery would be futile from those in whom surgery could be associated with a significant oncological benefit.

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Preoperative Prognostic Factors After Liver Resection for Non‐Colorectal, Non‐Neuroendocrine Liver Metastases and Validation of the Adam Score in an Asian Population

Cited by 12 publications

References 35 publications

Is resection for noncolorectal, nonneuroendocrine liver metastases justified?

Is resection for noncolorectal, nonneuroendocrine liver metastases justified?

The lack of selection criteria for surgery in patients with non-colorectal non-neuroendocrine liver metastases

The lack of selection criteria for surgery in patients with non-colorectal non-neuroendocrine liver metastases

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