Predicting 10-year survival after resection of colorectal liver metastases; an international study including biomarkers and perioperative treatment

Buisman, Florian E.; Giardiello, Daniele; Kemeny, Nancy E.; Steyerberg, Ewout W.; Höppener, Diederik J.; Galjart, Boris; Nierop, Pieter M. H.; Balachandran, Vinod P.; Cercek, Andrea; Drebin, Jeffrey A.; Gönen, Mithat; Jarnagin, William R.; Kingham, T. Peter; Vermeulen, Peter B.; Wei, Alice C.; Grünhagen, Dirk J.; Verhoef, Cornelis; D’Angelica, M.I.; Koerkamp, Bas Groot

doi:10.1016/j.ejca.2022.01.012

Cited by 30 publications

(42 citation statements)

References 49 publications

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“…CEA is a cell surface glycoprotein expressed by normal mucosal cells, but is overexpressed in cancers. The CEA level was useful for predicting CRLM patient outcomes [ 10 , 20 , 21 ]. We also found that CEA-positive young-onset CRLM patients had a worse prognosis than CEA-negative patients.…”

Section: Discussionmentioning

confidence: 99%

Nomogram Predicting the Survival of Young-Onset Patients with Colorectal Cancer Liver Metastases

Cheng

Chen

et al. 2022

Diagnostics

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Background: Although the global prevalence of colorectal cancer (CRC) is decreasing, there has been an increase in incidence among young-onset individuals, in whom the disease is associated with specific pathological characteristics, liver metastases, and a poor prognosis. Methods: From 2010 to 2016, 1874 young-onset patients with colorectal cancer liver metastases (CRLM) from the Surveillance, Epidemiology, and End Results (SEER) database were randomly allocated to training and validation cohorts. Multivariate Cox analysis was used to identify independent prognostic variables, and a nomogram was created to predict cancer-specific survival (CSS) and overall survival (OS). Receiver operating characteristic (ROC) curve, C-index, area under the curve (AUC), and calibration curve analyses were used to determine nomogram accuracy and reliability. Results: Factors independently associated with young-onset CRLM CSS included primary tumor location, the degree of differentiation, histology, M stage, N stage, preoperative carcinoembryonic antigen level, and surgery (all p < 0.05). The C-indices of the CSS nomogram for the training and validation sets (compared to TNM stage) were 0.709 and 0.635, and 0.735 and 0.663, respectively. The AUC values for 1-, 3-, and 5-year OS were 0.707, 0.708, and 0.755 in the training cohort and 0.765, 0.735, and 0.737 in the validation cohort, respectively; therefore, the nomogram had high sensitivity, and was superior to TNM staging. The calibration curves for the training and validation sets were relatively consistent. In addition, a similar result was observed with OS. Conclusions: We developed a unique nomogram incorporating clinical and pathological characteristics to predict the survival of young-onset patients with CRLM. This may serve as an early warning system allowing doctors to devise more effective treatment regimens.

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Section: Discussionmentioning

confidence: 99%

Nomogram Predicting the Survival of Young-Onset Patients with Colorectal Cancer Liver Metastases

Cheng

Chen

et al. 2022

Diagnostics

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“…The CRS is included for reference as most prognostic models used the CRS to compare the performance of their models [11]. Twelve prognostic models incorporating RAS mutation status as a predictor of outcomes after resection of CRLM have been published since 2017 [19][20][21][22][23][24][25][26][27][28][29][30]. Ten models were developed and validated by including patients from 2000 onwards, which parallels key developments in systemic chemotherapy such as the introduction of irinotecan and oxaliplatin as components of cytotoxic combination therapy and the use of biological agents such as bevacizumab, cetuximab, and panitumumab [4].…”

Section: Prognostic Models Incorporating Ras Mutation Statusmentioning

confidence: 99%

“…Ten models were developed and validated by including patients from 2000 onwards, which parallels key developments in systemic chemotherapy such as the introduction of irinotecan and oxaliplatin as components of cytotoxic combination therapy and the use of biological agents such as bevacizumab, cetuximab, and panitumumab [4]. Although the most recent, largest, and longest longitudinal study to date by Buisman et al, 2020 included patients from a long inclusion period (1992-2019) to estimate 10-year overall survival, the cohort largely reflects contemporary patient selection and treatment as most patients (82.0%) underwent resection after 2000 [30]. Nine studies included a validation cohort [21][22][23][25][26][27][28][29][30].…”

Section: Prognostic Models Incorporating Ras Mutation Statusmentioning

confidence: 99%

“…Although the most recent, largest, and longest longitudinal study to date by Buisman et al, 2020 included patients from a long inclusion period (1992-2019) to estimate 10-year overall survival, the cohort largely reflects contemporary patient selection and treatment as most patients (82.0%) underwent resection after 2000 [30]. Nine studies included a validation cohort [21][22][23][25][26][27][28][29][30]. The predicted outcome was overall survival in eight studies and recurrence-free survival in four studies.…”

Section: Prognostic Models Incorporating Ras Mutation Statusmentioning

confidence: 99%

“…At the other end of the spectrum, a C-statistic of one indicates that the prediction model always discriminates against patients who experience the outcome compared to those who do not [32]. The model by Buisman et al to predict 10-year overall survival documented the highest C-statistic (0.73) in its development cohort, while the remaining nine studies reported a C-statistic between 0.6 and 0.7 [20][21][22][23][25][26][27][28][29][30]. Calibration refers to a model's accuracy of risk estimates and indicates the extent to which expected and observed outcomes agree [33].…”

Section: Assessing the Performance Of Prediction Models Incorporating...mentioning

confidence: 99%

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Prognostic Models Incorporating RAS Mutation to Predict Survival in Patients with Colorectal Liver Metastases: A Narrative Review

Wong

Diakos

Molloy

et al. 2022

Cancers

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Recurrence and survival vary widely among patients who undergo curative-intent resection of colorectal liver metastases (CRLM). Prognostic models provide estimated probabilities of these outcomes and allow the effects of multiple potentially interacting variables to be adjusted and assessed simultaneously. Although many prognostic models based on clinicopathologic factors have been developed since the 1990s to predict survival after resection of CRLM, these models vary in their predictive performance when applied to contemporary cohorts. Rat sarcoma viral oncogene homolog (RAS) mutation status is routinely tested in patients with metastatic colorectal cancer to predict response to anti-epidermal growth factor therapy. In addition, mutations in RAS predict survival and recurrence in patients undergoing hepatectomy for CRLM. Several recent prognostic models have incorporated RAS mutation status as a surrogate of tumor biology and combined revised clinicopathologic variables to improve the prediction of recurrence and survival. This narrative review aims to evaluate the differences between contemporary prognostic models incorporating RAS mutation status and their clinical applicability in patients considered for curative-intent resection of CRLM.

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Incidence and Survival in Synchronous and Metachronous Liver Metastases From Colorectal Cancer

et al. 2022

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ImportanceAlthough treatment and prognosis of synchronous liver metastases from colorectal cancer are relatively well known, a comparative description of the incidence, epidemiological features, and outcomes of synchronous and metachronous liver metastases is lacking. The difference in prognosis between patients with synchronous and metachronous liver metastases is controversial.ObjectiveTo investigate temporal patterns in the incidence and outcomes of synchronous vs metachronous liver metastases from colorectal cancer.Design, Setting, and ParticipantsThis population-based cohort study used information from a French regional digestive cancer registry accounting for 1 082 000 inhabitants. A total of 26 813 patients with a diagnosis of incident colorectal adenocarcinoma diagnosed between January 1, 1976, and December 31, 2018, were included. Data were analyzed from February 7 to May 20, 2022.Main Outcomes and MeasuresAge-standardized incidence was calculated. Univariate and multivariate net survival analyses were performed.ResultsOf 26 813 patients with colorectal cancer (15 032 men [56.1%]; median [IQR] age, 73 [64-81] years), 4546 (17.0%) presented with synchronous liver metastases. The incidence rate of synchronous liver metastases was 6.9 per 100 000 inhabitants in men and 3.4 per 100 000 inhabitants in women, with no significant variation since 2000. The 5-year cumulative incidence of metachronous liver metastases decreased from 18.6% (95% CI, 14.9%-22.2%) during the 1976 to 1980 period to 10.0% (95% CI, 8.8%-11.2%) during the 2006 to 2011 period. Cancer stage at diagnosis was the strongest risk factor for liver metastases; compared with patients diagnosed with stage II cancer, patients with stage III cancer had a 2-fold increase in risk (subdistribution hazard ratio, 2.42; 95% CI, 2.08-2.82) for up to 5 years. Net survival at 1 year was 41.8% for synchronous liver metastases and 49.9% for metachronous metastases, and net survival at 5 years was 6.2% for synchronous liver metastases and 13.2% for metachronous metastases. Between the first (1976-1980) and last (2011-2016) periods, the adjusted ratio of death after synchronous and metachronous metastases was divided by 2.5 for patients with synchronous status and 3.7 for patients with metachronous status.Conclusions and RelevanceIn this study, the incidence of colorectal cancer with synchronous liver metastases changed little over time, whereas there was a 2-fold decrease in the probability of developing metachronous liver metastases. Survival improved substantially for patients with metachronous liver metastases, whereas improvement was more modest for those with synchronous metastases. The differences observed in the epidemiological features of synchronous and metachronous liver metastases from colorectal cancer may be useful for the design of future clinical trials.

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Predicting 10-year survival after resection of colorectal liver metastases; an international study including biomarkers and perioperative treatment

Cited by 30 publications

References 49 publications

Nomogram Predicting the Survival of Young-Onset Patients with Colorectal Cancer Liver Metastases

Nomogram Predicting the Survival of Young-Onset Patients with Colorectal Cancer Liver Metastases

Prognostic Models Incorporating RAS Mutation to Predict Survival in Patients with Colorectal Liver Metastases: A Narrative Review

Incidence and Survival in Synchronous and Metachronous Liver Metastases From Colorectal Cancer

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