Prognostic Scoring in Colorectal Cancer Liver Metastases

Abstract

Hypothesis: A prognostic scoring system for colorectal cancer liver metastases that is derived from unselected patients referred for hepatic resection would improve the applicability and increase the accuracy of prognostication. Design: Retrospective analysis of prospectively documented data; validation against an unrelated cohort from another institution. The median follow-up was 16.4 months (95% confidence interval, 15.0-17.8 months) (original cohort). Setting: Two tertiary referral centers at unrelated university hospitals. Patients: Independent prognosticators of survival were derived from 337 patients with colorectal cancer liver metastases referred for consideration of liver resection, and prognostic scores were calculated in 269 patients (79.8%) (original cohort). Calculation of prognostic scores was also applied to 193 patients referred and treated in an unrelated institution (validation cohort). Main Outcome Measures: Kaplan-Meier survival curve analysis (log-rank test) between different prognostic groups in the original and the validation cohorts. Results: Independent prognosticators of survival were Dukes stage, number of metastases, and serum concentrations of carcinoembryonic antigen, alkaline phosphatase, and albumin. Significant differences were found in cumulative overall survival between patients assigned to good, moderate, and poor prognoses in the original and validation cohorts (PϽ.05). Liver resection improved survival in all prognostic groups. However, no patient with poor prognosis and only 19.7% (13 of 66) of patients with moderate prognosis survived 5 years, compared with 62.5% (10 of 16) of patients with good prognosis (PϽ.001). Conclusions: This prognostic scoring system is derived from and can be applied to patients with colorectal cancer liver metastases at the time of referral for consideration of surgery. Patients with poor prognosis have no long-term benefit from curative liver resection and should therefore be considered for combined multimodal treatment.

Evaluation of the prognostic value of systemic inflammation and socioeconomic deprivation in patients with resectable colorectal liver metastases

“…51 Albumin was previously found to predict poor outcome both following resection of primary CRC 52 and in patients with metastatic disease. 53,54 The current study is the first to confirm that serum albumin is also an independent risk factor for poor outcome following CLM resection, though this prognostic value was inferior to that of the neutrophil count. Serum albumin was previously demonstrated to predict poor long-term outcome following cancer resection independently of CRP and has subsequently been combined with CRP to produce prognostic inflammatory scores validated in varied maligancies.…”

“…55,56 In summary, the results of this study confirm that systemic inflammatory biomarkers, routinely available preoperatively, independently predict long-term survival following resection of CLM. As demonstrated here and elsewhere 14,[30][31][32]53,54 merging of inflammatory indices with existing prognostic scoring systems may enable further refinement of patient prognosis, so guiding allocation of existing therapeutic modalities.…”

Prognostic Factors after Liver Resection for Colorectal Liver Metastasis

“…The most cited factor was the number of liver metastases, identified by 15 different studies 11,20,[32][33][34][35][36][37]39,40,[42][43][44]46,47 as a negative prognostic factor. Only four studies 38,41,45,48 did not present it as a negative prognostic factor of survival after resection of CRLM.…”

“…11,20,32,33,[35][36][37]39,42,[44][45][46] Nevertheless, six studies 34,38,40,41,47,48 concluded that regional lymph node metastases of primary tumor was not a significant prognostic factor for survival. This fact was supported by other studies not included in the analysis.…”

Neo-adjuvant chemotherapy followed by surgery versus surgery alone in high-risk patients with resectable colorectal liver metastases: The CHARISMA randomized multicenter clinical trial.

“…In the past, several clinical risk scores for the outcome of patients with CRLM have been published [7,[17][18][19][20][21][22][23][24][25]. In 1999, Fong et al described the most widely used CRS [19].…”