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Multicenter Study
. 2022 Jun;7(3):100470.
doi: 10.1016/j.esmoop.2022.100470. Epub 2022 Apr 20.

Predictive preoperative clinical score for patients with liver-only oligometastatic colorectal cancer

G Filippini Velázquez  1 , S Schiele  2 , M Gerken  3 , S Neumaier  4 , C Hackl  5 , P Mayr  1 , M Klinkhammer-Schalke  3 , G Illerhaus  4 , H J Schlitt  5 , M Anthuber  1 , T Kröncke  1 , H Messmann  1 , B Märkl  1 , C Schmid  1 , M Trepel  1 , G Müller  2 , R Claus  6 , B Hackanson  7
Affiliations
Multicenter Study

Predictive preoperative clinical score for patients with liver-only oligometastatic colorectal cancer

G Filippini Velázquez et al. ESMO Open. 2022 Jun.

Abstract

Background: Resection of liver metastases from colorectal cancer (CRC) in the oligometastatic stage improves survival and is a potentially curative treatment. Thus, predictive scores that reliably identify those patients who especially benefit from surgery are essential.

Patients and methods: In this multicenter analysis, 512 patients had undergone surgery for liver metastases from CRC. We investigated distinct cancer-specific risk factors that are routinely available in clinical practice and developed a predictive preoperative score using a training cohort (TC), which was thereafter tested in a validation cohort (VC).

Results: Inflammatory response to the tumor, a right-sided primary tumor, multiple liver metastases, and node-positive primary tumor were significant adverse variables for overall survival (OS). Patients were stratified in five groups according to the cumulative score given by the presence of these risk factors. Median OS for patients without risk factors was 133.8 months [95% confidence interval (CI) 81.2-not reached (nr)] in the TC and was not reached in the VC. OS decreased significantly for each subsequent group with increasing number of risk factors. Median OS was significantly shorter (P < 0.0001) for patients presenting all four risk factors: 14.3 months (95% CI 10.5 months-nr) in the TC and 16.6 months (95% CI 14.6 months-nr) in the VC.

Conclusions: Including easily obtainable variables, this preoperative score identifies oligometastatic CRC patients with prolonged survival rates that may be cured, and harbors potential to be implemented in daily clinical practice.

Keywords: clinical score; colorectal cancer; liver metastases; oligometastases; overall survival; predictive score; surgical resection.

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Conflict of interest statement

Disclosure The authors have declared no conflicts of interests.

Figures

Figure 1
Figure 1
Consort diagram of patients enrolled in the study. CRC, colorectal cancer; CRP, C-reactive protein; FAP, familial adenomatous polyposis; GIST, gastrointestinal stromal tumor; NET, neuroendocrine tumor; RFA, radiofrequency ablation; SCC, squamous cell carcinoma. aPatients with liver metastases from CRC not treated in curative intention with surgical resection of liver metastases (e.g. only RFA, only chemotherapy), documented to die from postoperative complications (not from tumor progression), postoperative histological diagnosis other than adenocarcinoma of the colon (NET, GIST, SCC), with FAP, incomplete data for CRP values, CRP values older than 30 days before liver surgery, concurrent infectious disease or inflammation due to complications of tumor progression, extrahepatic metastases, diffuse peritoneal metastases. bTumor Center Regensburg, University of Regensburg.
Figure 2
Figure 2
Stratification of patients according to the number of risk factors. Overall survival for the training (left) and validation cohorts (right) are shown.
See this image and copyright information in PMC

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