Comprehensive Evaluation of Relapse Risk (CERR) Score for Colorectal Liver Metastases: Development and Validation

Abstract

Background The calculation of the tumor burden score (TBS) is not perfect because the bilobar spread of colorectal liver metastasis (CRLM) is neglected. The identification of an ideal prognostic scoring system for CRLM remains controversial. Materials and Methods Patients who underwent curative intent liver resection for CRLM from one medical center were enrolled in cohort 1 (787 patients) and cohort 2 (162 patients). Tumor relapse‐free survival (RFS) was the main outcome. A Cox regression model was used to identify independent predictors of prognosis. The time‐dependent area under the curve, calibration curve, and C‐index were employed to validate the predictive ability of the survival model. Results Modified TBS (mTBS) was established by a mathematical equation with parameters including CRLM size, CRLM number, and unilobar or bilobar metastasis. Five preoperative predictors of worse RFS were identified in cohort 1 and incorporated into the Comprehensive Evaluation of Relapse Risk (CERR) score: KRAS/NRAS/BRAF‐mutated tumor (1 point); node‐positive primary (1 point); extrahepatic disease (1 point); carcinoembryonic antigen level > 200 ng/mL or carbohydrate antigen 19‐9 (CA19‐9) >200 U/mL (1 point); and mTBS between 5 and 11 (1 point) or 12 and over (2 points). Patients in cohort 1 were stratified by their CERR score into risk groups: the high‐risk group (CERR score 4 or more), the medium‐risk group (CERR score 2–3), and the low‐risk group (CERR score 0–1). Importantly, internal validation in cohort 1 and further validation in cohort 2 both showed the superior discriminatory capacity of the CERR score. Conclusion mTBS should be promoted. The CERR score is a powerful prognostic tool that can help determine optimal clinical management strategies. Implications for Practice This work resulted in the successful modification of the tumor burden score and development of a comprehensive and practical prognostic scoring system—the Comprehensive Evaluation of Relapse Risk (CERR) score. The CERR score, with a better prognostic discriminatory ability, outperformed the Fong score. Perhaps more importantly, the CERR score is a powerful prognostic tool because it unified the most consistently reported prognostic factors. Therefore, the CERR score can assist doctors in determining optimal clinical management strategies.

The Era of Radiogenomics in Precision Medicine: An Emerging Approach to Support Diagnosis, Treatment Decisions, and Prognostication in Oncology

“…These extracted quantitative data reflect the crucial part of the establishment of radiomics prediction models. In practice, 50 to 5,000 radiomic features processed by specific software, including PyRadiomics ( 32 , 33 ), CERR ( 34 , 35 ) or IBEX ( 36 , 37 ), are usually divided into morphological, intensity-based, and dynamic features ( 14 ) ( Figure 2 ). Morphology-based features can collect three-dimensional (3D) shape characteristics, including volume, surface area, and sphericity.…”

Nomograms incorporating preoperative RDW level for the prediction of postoperative complications and survival in colorectal liver metastases after resection

“…This study also constructed novel nomograms for the prediction of survival. Some nomograms have been developed to predict individual survival probabilities for patients with CRLM undergoing liver resection (7,8). However, the nomograms developed here have the following specific advantages.…”

“…Nomograms incorporating and illustrating important prognostic factors have been widely used as reliable tools for predicting survival probabilities for individual patients. Chen et al (7) established a comprehensive evaluation of relapse risk score based on KRAS status, primary node status, extrahepatic disease, carcinoembryonic antigen (CEA) level, and tumour burden score to predict the prognosis of patients with CRLM. Liu et al (8) revealed that a nomogram constructed according to tumour size, liver metastasis number, RAS mutation status, and primary lymph node metastasis has a favorable calibration and C-index for predicting survival in patients with CRLM.…”

Perioperative Systemic Chemotherapy for Colorectal Liver Metastasis: Recent Updates

“…Tumor biology including chemosensitivity can facilitate subsequent treatment strategies. Several scoring systems were developed to predict the recurrence and prognosis in CLM [ 7 , 8 , 9 ]. Previous scoring systems included disease-free interval, the size and number of LM, the staging of tumor and node, the level of carcinoembryonic antigen (CEA), tumor grade, margin status and age [ 7 , 8 , 9 ].…”

“…Several scoring systems were developed to predict the recurrence and prognosis in CLM [ 7 , 8 , 9 ]. Previous scoring systems included disease-free interval, the size and number of LM, the staging of tumor and node, the level of carcinoembryonic antigen (CEA), tumor grade, margin status and age [ 7 , 8 , 9 ]. Fong et al suggested five clinical criteria as a clinical risk score including nodal involvement, DFS from the primary to LM < 12 months, number of LM > 1, CEA > 200 ng/mL, the largest tumor >5 cm [ 8 ].…”