Hepatobiliary Tumors

Annals of Surgical Oncology

, Volume 18, Issue 10, pp 2757-2763

Open Access This content is freely available online to anyone, anywhere at any time.

Is the Clinical Risk Score for Patients with Colorectal Liver Metastases Still Useable in the Era of Effective Neoadjuvant Chemotherapy?

  • Ninos AyezAffiliated withDivision of Surgical Oncology, Erasmus University MC, Daniel den Hoed Cancer Center
  • , Zarina S. LalmahomedAffiliated withDivision of Transplantation and Hepatobiliary Surgery, Erasmus University MC
  • , Anne E. M. van der PoolAffiliated withDivision of Surgical Oncology, Erasmus University MC, Daniel den Hoed Cancer Center
  • , Yvonne VergouweAffiliated withDivision of Public Health, Center for Medical Decision Making
  • , Kees van MontfortAffiliated withDivision of Biostatistics, Erasmus University MC, Daniel den Hoed Cancer Center
  • , Jeroen de JongeAffiliated withDivision of Surgical Oncology, Erasmus University MC, Daniel den Hoed Cancer CenterDivision of Transplantation and Hepatobiliary Surgery, Erasmus University MC
  • , Alexander M. M. EggermontAffiliated withInstitut de cancérologie Gustav Roussy
  • , Jan N. M. IJzermansAffiliated withDivision of Transplantation and Hepatobiliary Surgery, Erasmus University MC
  • , Cornelis VerhoefAffiliated withDivision of Surgical Oncology, Erasmus University MC, Daniel den Hoed Cancer Center Email author 

Abstract

Background

Several clinical risk scores (CRSs) for the outcome of patients with colorectal liver metastases have been validated, but not in patients undergoing neoadjuvant chemotherapy. Therefore, this study evaluates the predictive value of these CRSs in this specific group.

Methods

Between January 2000 and December 2008, all patients undergoing a metastasectomy were analyzed and divided into two groups: 193 patients did not receive neoadjuvant chemotherapy (group A), and 159 patients received neoadjuvant chemotherapy (group B). In group B, the CRSs were calculated before and after administration of neoadjuvant chemotherapy. Results were evaluated by using the CRSs proposed by Nordlinger et al., Fong et al., Nagashima et al., and Konopke et al.

Results

In groups A and B, the overall median survival was 43 and 47 months, respectively (P = 0.648). In group A, all CRSs used were of statistically significant predictive value. Before administration of neoadjuvant chemotherapy, only the Nordlinger score was of predictive value. After administration of neoadjuvant chemotherapy, all CRSs were of predictive value again, except for the Konopke score.

Conclusions

Traditional CRSs are not a reliable prognostic tool when used in patients before treatment with neoadjuvant chemotherapy. However, CRSs assessed after the administration of neoadjuvant chemotherapy are useful to predict prognosis.