Assessing tools for management of noncolorectal nonneuroendocrine liver metastases: External validation of a prognostic model

Tsang, Melanie; Mahar, Alyson; Martel, Guillaume; Cleary, Sean P.; Nanji, Sulaiman; Ouellet, Jean-François; Hernandez‐Alejandro, Roberto; Wei, Alice C.; Hallet, Julie

doi:10.1002/jso.25228

Cited by 4 publications

(2 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

Surgical Management of Genitourinary Cancer Liver Metastases

Martel¹,

Bertens²,

Canil³

2021

Surgical Oncology Clinics of North America

View full text Add to dashboard Cite

Assessing tools for management of noncolorectal nonneuroendocrine liver metastases: External validation of a prognostic model

Abstract: While long-term survival is achievable, discrimination of the AFC score is not maintained in a geographic external cohort of resected NCNNELM. It is not generalizable to this external population.

Cited by 4 publications

References 20 publications

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

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

Surgical Management of Genitourinary Cancer Liver Metastases

Contact Info

Product

Resources

About