Prognostic factors in colorectal liver metastases patients with various tumor numbers treated by liver resection: a single-center, retrospective study

Abstract

Background Multiple liver metastases is considered a risk factor for overall survival of colorectal liver metastases patients (CRLM) after curative resection. However, whether the prognostic factors were constant in patients with various liver metastases (LM) numbers has not been adequately investigated. This retrospective study aimed to evaluate the changing of prognostic factors on overall survival (OS) in CRLM patients with various LM after curative resection. Methods Patients who underwent liver resection for CRLM between January 2000 and November 2020 were retrospectively studied. They were divided into three subgroups according to LM numbers by X-tile analysis. Multivariable analysis identified prognostic factors in each subgroup. Nomograms were built using different prognostic factors in three subgroups, respectively. Performance of the nomograms was assessed according to the concordance index (C-index) and calibration plots. The abilities of different scoring systems predicting OS were compared by calculating the area under the time-dependent receiver operating characteristic (ROC) curve (AUC). Results A total of 1095 patients were included. Multivariable analysis showed tumor number increasing was an independent risk factor. Patients were subsequently divided into 3 subgroups according to the number of LM by X-tile analysis, namely solitary (n = 375), 2–4 (n = 424), and ≥ 5 (n = 296). The 3-year and 5-year OS rates were 64.1% and 54.0% in solitary LM group, 58.1% and 41.7% in 2–4 LM group, and 50.9% and 32.0% in ≥ 5 LM group, respectively (p < 0.001). In multivariable analysis, RAS mutation was the only constant independent risk factor in all subgroups. The nomograms were built to predict survival based on independent factors in three subgroups. The C-index for OS prediction was 0.707 (95% CI 0.686–0.728) in the solitary LM group, 0.695 (95% CI 0.675–0.715) in the 2–4 LM group, and 0.687 (95% CI 0.664–0.710) in the ≥ 5 LM group. The time-dependent AUC values of nomograms developed using different risk factors after stratifying patients by tumor number were higher than the traditional scoring systems without patient stratification. Conclusions The prognostic factors varied among CRLM patients with different LM numbers. RAS mutation was the only constant risk factor. Building prediction models based on different prognostic factors improve patient stratification.

Predicting Trifluridine/Tipiracil Treatment Outcomes in Refractory Metastatic Colorectal Cancer Patients: A Multicenter Exploratory Analysis

“…The liver metastases in mCRC have a known negative impact on survival and have been proven to be a negative predictive factor for TTP treatment [17]. Furthermore, the number of metastases is a prognostic factor affecting survival [30]. The majority of our patients (78.8%) had metastases present in the liver which corresponds to the 80.9% in the intent-to-treat population in the RECOURSE study.…”

Somatic Mutations in Surgically Treated Colorectal Liver Metastases: An Overview

“…As precision medicine has gained traction in the medical field, previous studies have aimed to identify prognostic factors for CRLM patients [9][10][11]. Among these, somatic genetic mutations, such as mutations in RAS, BRAF, mismatch repair (MMR) genes, TP53, and SMAD4, are of particular interest, as understanding a patient's unique genetic profile can pave the way for individualized treatment.…”

The Surgical Outcome and Prognostic Factors for Solitary Colorectal Liver Metastasis

“…Most of the literature covers medical records from a relatively long time ago as well. (7,12,13) However, the latest article also considers lung metastasis as a potential risk factor in this context. (7) The advantage of our study is that we focus speci cally on CRLM with solitary liver metastasis without any other metastases.…”

“…(7,12,13) However, the latest article also considers lung metastasis as a potential risk factor in this context. (7) The advantage of our study is that we focus speci cally on CRLM with solitary liver metastasis without any other metastases. Additionally, the patient data recorded in this study are all treated according to the treatment trends of the past decade.…”