Clinical Score for Predicting Recurrence After Hepatic Resection for Metastatic Colorectal Cancer

Fong, Yuman; Fortner, Joseph G.; Sun, Ruth L.; Brennan, Murray F.; Blumgart, Leslie H.

doi:10.1097/00000658-199909000-00004

Cited by 3,350 publications

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“…The clinical risk score, as defined previously, was evaluated. 1 Briefly, a point was assessed for each of the following five factors: (1) disease-free interval less than 12 months, (2) node-positive primary colorectal cancer, (3) greater than one tumor, (4) size of largest tumor greater than 5 cm and (5) pre-hepatectomy CEA 4200 ng/ml.…”

Section: Clinical Informationmentioning

confidence: 99%

“…Although 20 to 25% of colorectal carcinoma patients present with synchronous liver metastases, another 60% develop such metastases after the diagnosis of the primary tumor. 1,2 Surgical resection is potentially curative for colorectal cancer metastases confined to the liver, with a 5-year survival rate between 30 and 50%. 3 Some patients, however, recur early after resection and have a poor outcome.…”

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confidence: 99%

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Folate receptor-α expression in resectable hepatic colorectal cancer metastases: patterns and significance

et al. 2011

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Folate receptor alpha (FRa), encoded by folate receptor 1 (adult) gene, has emerged as a cancer biomarker and potential therapeutic target. In addition, its expression in tumors may offer prognostic information. The aim of this study was to assess the prognostic value of FRa expression and other common molecular markers in resected liver metastases from colorectal cancer. To maximize potential biological differences, we selected two groups of patients with markedly different outcomes as study subjects. Immunohistochemical analysis of FRa expression and other common markers (thymidylate synthase, p53, p27, BCL2, ki67, MLH1, MSH2 and MGMT) on tissue microarrays was carried out on samples from 160 patients; 56 patients survived at least 10 years following liver resection, and 104 died within 2 years of surgery. These markers were evaluated and compared with standard clinical predictors of outcome including a previously validated clinical risk score. Our results showed that in addition to known clinical risk factors, FRa positivity was significantly associated with the early death group (32% compared with 13%; P ¼ 0.03). None of the other common molecular markers were differentially expressed between the two groups. On multivariate analysis, clinical risk score, margin status and FRa expression were independently associated with outcome. Specific multivariate comparisons confirmed that FRa expression was associated with outcome independent of the clinical risk score and margin. These data demonstrate that FRa expression is present in a subset of resected hepatic colorectal cancer metastases, and this marker is independently associated with survival after hepatic resection. The prognostic value of FRa expression and the utility of FRa-targeted therapies in stage-IV colorectal cancer patients deserve further exploration. Modern Pathology (2011) 24, 1221-1228; doi:10.1038/modpathol.2011.82; published online 13 May 2011Keywords: folate receptor 1 (adult); folate-targeted therapy; liver metastasisThe liver is the most common site of metastasis from colorectal carcinoma. Although 20 to 25% of colorectal carcinoma patients present with synchronous liver metastases, another 60% develop such metastases after the diagnosis of the primary tumor. 1,2 Surgical resection is potentially curative for colorectal cancer metastases confined to the liver, with a 5-year survival rate between 30 and 50%. 3 Some patients, however, recur early after resection and have a poor outcome. A clinical risk score developed by Fong et al 1 incorporates five preoperative criteria including nodal status of the primary lesion, disease-free interval, number of hepatic metastases, size of the largest metastasis and preoperative carcinoembryonic antigen (CEA) level. This

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Section: Clinical Informationmentioning

confidence: 99%

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confidence: 99%

Folate receptor-α expression in resectable hepatic colorectal cancer metastases: patterns and significance

et al. 2011

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“…The liver is the organ to which CRC most frequently metastasizes, with 15-25% of patients having synchronous colorectal liver metastases (CRLM) at presentation and a further 25-50% ultimately developing CRLM following resection of the primary tumor [2]. Hepatic resection offers the only hope of cure to patients with CRLM, providing 5-year survival rates of 30-50% depending upon selection criteria [3][4][5]. Unfortunately, cancer recurs in up to 75% of patients following hepatectomy, in the remnant liver and/or other sites [5].…”

Section: Introductionmentioning

confidence: 99%

Repeat hepatectomy is independently associated with favorable long‐term outcome in patients with colorectal liver metastases

et al. 2017

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Up to three-quarters of patients undergoing liver resection for colorectal liver metastases (CRLM) develop intrahepatic recurrence. Repeat hepatic resection appears to provide the optimal chance of cure for these patients. The aim of this study was to analyze short-and long-term outcomes following index and repeat hepatectomy for CRLM. Clinicopathological data were obtained from a prospectively maintained database. Perioperative variables and outcomes were compared using the Chi-squared test. Variables associated with long-term survival following index and second hepatectomy were identified by Cox regression analyses. Over the study period, 488 patients underwent hepatic resection for CRLM, with 71 patients undergoing repeat hepatectomy. There was no significant difference in rates of morbidity (P = 0.135), major morbidity (P = 0.638), or mortality (P = 0.623) when index and second hepatectomy were compared. Performance of repeat hepatectomy was independently associated with increased overall and cancer-specific survival following index hepatectomy. Short diseasefree interval between index and second hepatectomy, number of liver metastases >1, and resection of extrahepatic disease were independently associated with shortened survival following repeat resection. Repeat hepatectomy for recurrent CRLM offers short-term outcomes equivalent to those of patients undergoing index hepatectomy, while being independently associated with improved longterm patient survival. Cancer MedicineOpen Access 332

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“…In most series, up to 25% of patients presenting with stage IV CRC undergo hepatic resection (Kopetz et al, 2009), with reported 5-year survival rates up to 50% (Taylor et al, 2010;Choti et al, 2002;Chua et al, 2011). However over one-half of patients will develop recurrence within 2 years (de Jong et al, 2009;Fong et al, 1999;Nordlinger et al, 1996), not getting any long-term survival benefit from hepatic resection.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore difficulties remain in deciding who is a good candidate for liver resection. Many studies have examined several clinical and pathological factors, including number and size of CLM, disease-free interval from primary to CLM, carcinoembryonic antigen (CEA) level, primary tumor stage, synchronous or metachronous CLM, as potential prognostic determinants of survival after surgical resection of CLM, in order to establish a preoperative scoring system that is able to predict the risk of recurrence after resection, and ultimately allows the selection of those patients who may benefit more from surgery (Choti et al, 2002;de Jong et al, 2009;Fong et al, 1999;Nordlinger et al, 1996;Mann et al, 2004;Nagashima et al, 2006a,b).…”

Section: Introductionmentioning

confidence: 99%

Can KRAS and BRAF mutations limit the benefit of liver resection in metastatic colorectal cancer patients? A systematic review and meta-analysis

Passiglia

Bronte

Bazan

et al. 2016

Critical Reviews in Oncology/Hematology

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Background: Clinical trials investigated the potential role of both KRAS and BRAF mutations, as prognostic biomarkers, in colorectal cancer (CRC) patients who underwent surgical treatment of CRC-related liver metastases (CLM), showing conflicting results. This meta-analysis aims to review all the studies reporting survival outcomes (recurrence free survival (RFS), and/or overall survival (OS)) of patients undergoing resection of CLM, stratified according to KRAS and/or BRAF mutation status. Materials and methods: Data from all published studies reporting survival outcomes (RFS and/or OS) of CRC patients who received resection of CLM, stratified by KRAS and/or BRAF mutation status were collected, according to the PRISMA guidelines. Pooled HRs were calculated for both the OS and/or RFS. Results: Seven eligible trials (1403 patients) were included. Pooled analysis showed that KRAS mutations predicted a significantly worse both RFS (HR: 1.65; 95% CI: 1.23-2.21) and OS (HR: 1.86; 95% CI: 1.51-2.30) in patients who underwent surgical resection of CLM. BRAF mutations were also associated with a significantly worse OS (HR: 3.90; 95% CI: 1.96-7.73) in this subgroup of patients. Conclusions: This meta-analysis suggests both KRAS and BRAF mutations as poor, prognostic biomarkers, associated with worse survival outcomes, in patients undergoing hepatic resection of CLM

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Clinical Score for Predicting Recurrence After Hepatic Resection for Metastatic Colorectal Cancer

Cited by 3,350 publications

References 26 publications

Folate receptor-α expression in resectable hepatic colorectal cancer metastases: patterns and significance

Folate receptor-α expression in resectable hepatic colorectal cancer metastases: patterns and significance

Repeat hepatectomy is independently associated with favorable long‐term outcome in patients with colorectal liver metastases

Can KRAS and BRAF mutations limit the benefit of liver resection in metastatic colorectal cancer patients? A systematic review and meta-analysis

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