Is the Clinical Risk Score for Patients with Colorectal Liver Metastases Still Useable in the Era of Effective Neoadjuvant Chemotherapy?

Abstract

BackgroundSeveral clinical risk scores (CRSs) for the outcome of patients with colorectal liver metastases have been validated, but not in patients undergoing neoadjuvant chemotherapy. Therefore, this study evaluates the predictive value of these CRSs in this specific group.MethodsBetween January 2000 and December 2008, all patients undergoing a metastasectomy were analyzed and divided into two groups: 193 patients did not receive neoadjuvant chemotherapy (group A), and 159 patients received neoadjuvant chemotherapy (group B). In group B, the CRSs were calculated before and after administration of neoadjuvant chemotherapy. Results were evaluated by using the CRSs proposed by Nordlinger et al., Fong et al., Nagashima et al., and Konopke et al.ResultsIn groups A and B, the overall median survival was 43 and 47 months, respectively (P = 0.648). In group A, all CRSs used were of statistically significant predictive value. Before administration of neoadjuvant chemotherapy, only the Nordlinger score was of predictive value. After administration of neoadjuvant chemotherapy, all CRSs were of predictive value again, except for the Konopke score.ConclusionsTraditional CRSs are not a reliable prognostic tool when used in patients before treatment with neoadjuvant chemotherapy. However, CRSs assessed after the administration of neoadjuvant chemotherapy are useful to predict prognosis.

Surgery for colorectal liver metastases: The evolution of determining prognosis

“…Moreover, despite some external validation, these score are based on single-institution cohorts and have not been modified based on newer developments in treatments. Lastly, the variations observed in the OS of patients with similar prognostic scores suggest that other factors may play a role in determining survival after resection of CRLM, most intriguingly patientspecific biological and molecular factors [78] .…”

Optimal Morphologic Response to Preoperative Chemotherapy: An Alternate Outcome End Point Before Resection of Hepatic Colorectal Metastases

“…[15][16][17][18][19][20] However, many of these clinical risk scores were developed using patient data that predated modern chemotherapy, making their application to patients treated with a contemporary multidisciplinary approach controversial. 21,22 Previously, our group and others have reported that improved survival correlates with pathologic response to preoperative chemotherapy, which we proposed as a new outcome end point after resection of CLM.…”

Clinical Scoring Systems for Stratifying Risk after Resection of Hepatic Colorectal Metastases: Still Relevant?

“…11,12 In this issue of Annals of Surgical Oncology, Ayez et al examine this topic with a detailed analysis of four wellknown scoring systems and the effect of neoadjuvant therapy on their prognostic power. 13 The authors confirm that although all four classification systems effectively stratify risk and survival in patients taken directly to operation, prior treatment with neoadjuvant therapy greatly diminishes their predictive capacity. When scores were calculated before administering neoadjuvant therapy, only one of the four systems maintained significance for predicting disease-free survival and/or disease-specific survival.…”