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. 2018 Aug;105(9):1210-1220.
doi: 10.1002/bjs.10838. Epub 2018 Apr 25.

Genetic And Morphological Evaluation (GAME) score for patients with colorectal liver metastases

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Genetic And Morphological Evaluation (GAME) score for patients with colorectal liver metastases

G A Margonis et al. Br J Surg. 2018 Aug.

Abstract

Background: This study sought to develop a clinical risk score for resectable colorectal liver metastasis (CRLM) by combining clinicopathological and clinically available biological indicators, including KRAS.

Methods: A cohort of patients who underwent resection for CRLM at the Johns Hopkins Hospital (JHH) was analysed to identify independent predictors of overall survival (OS) that can be assessed before operation; these factors were combined into the Genetic And Morphological Evaluation (GAME) score. The score was compared with the current standard (Fong score) and validated in an external cohort of patients from the Memorial Sloan Kettering Cancer Center (MSKCC).

Results: Six preoperative predictors of worse OS were identified on multivariable Cox regression analysis in the JHH cohort (502 patients). The GAME score was calculated by allocating points to each patient according to the presence of these predictive factors: KRAS-mutated tumours (1 point); carcinoembryonic antigen level 20 ng/ml or more (1 point), primary tumour lymph node metastasis (1 point); Tumour Burden Score between 3 and 8 (1 point) or 9 and over (2 points); and extrahepatic disease (2 points). The high-risk group in the JHH cohort (GAME score at least 4 points) had a 5-year OS rate of 11 per cent, compared with 73·4 per cent for those in the low-risk group (score 0-1 point). Importantly, in cohorts from both the JHH and MSKCC (747 patients), the discriminatory capacity of the GAME score was superior to that of the Fong score, as demonstrated by the C-index and the Akaike information criterion.

Conclusion: The GAME score is a preoperative prognostic tool that can be used to inform treatment selection.

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Conflict of interest statement

Conflicts of Interest / Financial Disclosures: None to report

Figures

Figure 1
Figure 1
A. Kaplan Meier analysis of overall survival (OS) for different values of the GAME score in the Johns Hopkins Hospital (JHH) cohort B. Kaplan Meier analysis of OS for different values of the Fong score in the JHH cohort C. Kaplan Meier analysis of OS for different GAME score risk subgroups in the JHH cohort D. Kaplan Meier analysis of OS for different Fong score risk subgroups in the JHH cohort
Figure 2
Figure 2
A. Kaplan Meier analysis of OS for different values of the GAME score in the Memorial Sloan Kettering Cancer Center (MSKCC) cohort B. Kaplan Meier analysis of OS for different values of the Fong score in the MSKCC cohort C. Kaplan Meier analysis of OS for different GAME score risk subgroups in the MSKCC cohort D. Kaplan Meier analysis of OS for different Fong score risk subgroups in the MSKCC cohort
Figure 3
Figure 3
A. Kaplan Meier analysis of recurrence-free survival (RFS) for different values of the GAME score in the JHH cohort B. Kaplan Meier analysis of recurrence-free survival (RFS) for different values of the GAME score in the MSKCC cohort

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