Nomogram predicting early recurrence defined by the minimum P value approach for colorectal liver metastasis patients receiving colorectal cancer resection with simultaneous liver metastasis resection: development and validation

Abstract

Background Simultaneous resections have been increasingly performed for colorectal liver metastasis patients. However, studies explored risk stratification for these patients are scarce. Among which, a clear definition of early recurrence remains controversial and models for predicting early recurrence in these patients are lacking. Methods Colorectal liver metastasis patients who developed recurrence followed by simultaneous resection were enrolled. Early recurrence was determined by the minimum P value method, and patients were divided into an early recurrence group and late recurrence group. Standard clinical data were collected from each patient including demographics features, preoperative laboratory tests and postoperative regular follow-up results. All the data were accessed by clinicians and recorded accordingly. The nomogram for early recurrence was constructed in the training cohort and validated externally in the test cohort. Results The optimal value of early recurrence by the minimum P value method was 13 months. A total of 323 patients were included in the training cohort, of which 241 (74.6%) experienced early recurrence. Seventy-one patients were included in the test cohort, of which 49 (69.0%) experienced early recurrence. Significantly worse post-recurrence survival (median 27.0 vs. 52.8 months, P=0.00083) and overall survival (median 33.8 vs. 70.9 months, P<0.0001) were observed in patients with early recurrence in the training cohort. Positive lymph node metastases (P=0.003), tumour burden scores ≥4.09 (P=0.001), preoperative neutrophil-to-lymphocyte ratios ≥1.44 (P=0.006), preoperative blood urea nitrogen levels ≥3.55 µmol/L (P=0.017) and postoperative complications (P=0.042) were independently associated with early recurrence, and all these predictors were included in the nomogram. The nomogram for predicting early recurrence had a receiver operating characteristic curve of 0.720 in the training cohort and a receiver operating characteristic curve of 0.740 in the test cohort. The Hosmer-Lemeshow test and calibration curves showed acceptable model calibration in the training set (P=0.7612) and in the test set (P=0.8671). The decision curve analysis results for the training cohort and test cohort also indicated that the nomogram showed good clinical applicability. Conclusions Our findings provide clinicians with new insights into accurate risk stratification for colorectal liver metastasis patients receiving simultaneous resection and contributing to the management of patients.

Clinical Prediction Models for Prognosis of Colorectal Liver Metastases: A Comprehensive Review of Regression-Based and Machine Learning Models

“…Ten studies developed prognostic models for prediction of recurrence [21,26,30,34,55,62,63,72,79,85]. Regression-based methods were used in seven studies [26,34,55,63,72,79,85], and the remaining three studies used ML techniques, including the least absolute shrinkage and selection operator (LASSO) [62], gradient-boosted trees (GBT) [30] and random forest (RF) with a globally optimal decision tree (OPT) analysis [21].…”

“…Ten studies developed prognostic models for prediction of recurrence [21,26,30,34,55,62,63,72,79,85]. Regression-based methods were used in seven studies [26,34,55,63,72,79,85], and the remaining three studies used ML techniques, including the least absolute shrinkage and selection operator (LASSO) [62], gradient-boosted trees (GBT) [30] and random forest (RF) with a globally optimal decision tree (OPT) analysis [21]. The latter was employed to identify the ideal margin width that minimizes the probability of intrahepatic recurrence within 5 years, and margins between 9 and 11 mm were proposed according to the diameter of the largest CRLM, the primary tumour nodal status and the primary tumour site [21].…”

“…The latter was employed to identify the ideal margin width that minimizes the probability of intrahepatic recurrence within 5 years, and margins between 9 and 11 mm were proposed according to the diameter of the largest CRLM, the primary tumour nodal status and the primary tumour site [21]. Four studies attempted to predict early recurrence, defined either as recurrence within 6 months using a previously established definition [34,79] or by performing an additional analysis that suggested cut-offs at 11 or 13 months [55,72].…”

“…Six recent Asian studies focused on patients undergoing simultaneous resections of the primary and metastatic tumours [37,[51][52][53]72,82]. Outcomes studied included OS [53,82], CSS [82], PFS [37,51], recurrence [37,72], serious postoperative complications [52] and presence of lymph node (LN) metastases [51].…”

Prediction of early recurrence in patients with colorectal liver metastases

“…We have carefully reviewed the article published in Journal of Gastrointestinal Oncology by Deng et al The authors have successfully developed and validated a predictive model for early recurrence in patients with colorectal liver metastases (CRLM) who underwent colorectal cancer (CRC) resection along with simultaneous liver metastasis resection, using the minimum P value approach ( 1 ). We appreciate the authors for their significant contributions to the field of CRLM treatment and prognosis, but we would like to offer a few points that merit further consideration and discussion.…”