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Multicenter Study
. 2023 Sep 5;7(5):zrad085.
doi: 10.1093/bjsopen/zrad085.

Development and validation of a novel risk score to predict overall survival following surgical clearance of bilobar colorectal liver metastases

Bobby V M Dasari  1   2 , Dimitri Raptis  3 , Nicholas Syn  4 , Alejandro Serrablo  5 , Jose Manuel Ramia  6 , Andrea Laurenzi  7 , Christian Sturesson  8 , Timothy M Pawlik  9 , Ajith K Siriwardena  10 , Mickael Lesurtel  11 ; BiCRLM study collaborators
Collaborators, Affiliations
Multicenter Study

Development and validation of a novel risk score to predict overall survival following surgical clearance of bilobar colorectal liver metastases

Bobby V M Dasari et al. BJS Open. .

Erratum in

Abstract

Background: Bilobar liver metastases from colorectal cancer pose a challenge for obtaining a satisfactory oncological outcome with an adequate future liver remnant. This study aimed to assess the clinical and pathological determinants of overall survival and recurrence-free survival among patients undergoing surgical clearance of bilobar liver metastases from colorectal cancer.

Methods: A retrospective international multicentre study of patients who underwent surgery for bilobar liver metastases from colorectal cancer between January 2012 and December 2018 was conducted. Overall survival and recurrence-free survival at 1, 2, 3 and 5 years after surgery were the primary outcomes evaluated. The secondary outcomes were duration of postoperative hospital stay, and 90-day major morbidity and mortality rates. A prognostic nomogram was developed using covariates selected from a Cox proportional hazards regression model, and internally validated using a 3:1 random partition into derivation and validation cohorts.

Results: A total of 1236 patients were included from 70 centres. The majority (88 per cent) of the patients had synchronous liver metastases. Overall survival at 1, 2, 3 and 5 years was 86.4 per cent, 67.5 per cent, 52.6 per cent and 33.8 per cent, and the recurrence-free survival rates were 48.7 per cent, 26.6 per cent, 19.2 per cent and 10.5 per cent respectively. A total of 25 per cent of patients had recurrent disease within 6 months. Margin positivity and progressive disease at liver resection were poor prognostic factors, while adjuvant chemotherapy in margin-positive resections improved overall survival. The bilobar liver metastases from colorectal cancer-overall survival nomogram was developed from the derivation cohort based on pre- and postoperative factors. The nomogram's ability to forecast overall survival at 1, 2, 3 and 5 years was subsequently validated on the validation cohort and showed high accuracy (overall C-index = 0.742).

Conclusion: Despite the high recurrence rates, overall survival of patients undergoing surgical resection for bilobar liver metastases from colorectal cancer is encouraging. The novel bilobar liver metastases from colorectal cancer-overall survival nomogram helps in counselling and informed decision-making of patients planned for treatment of bilobar liver metastases from colorectal cancer.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
BiCRLM-OS nomogram for the prediction of overall survival. BiCRLM-OS, bilobar colorectal liver metastases-overall survival; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease.
Fig. 2
Fig. 2
Overall survival (OS) in the derivation cohort based on individual risk scores of BiCRLM-OS nomogram. BiCRLM-OS, bilobar colorectal liver metastases-overall survival.
Fig. 3
Fig. 3
Kaplan-Meier curves of the risk groups based on BiCRLM-OS risk score in the derivation cohort. BiCRLM-OS, bilobar colorectal liver metastases-overall survival.
Fig. 4
Fig. 4
Discrimination of BiCRLM-OS risk score for OS at 1-, 2-, 3- and 5-year intervals in the derivation and validation cohorts. BiCRLM-OS, bilobar colorectal liver metastases-overall survival; AUC, area under the curve; TPR, true positivity rate; FPR, false positivity rate.
See this image and copyright information in PMC

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