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Validation of Prognostic Scoring Systems for Patients Undergoing Resection of Colorectal Cancer Liver Metastases

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Several prognostic scoring systems have been established for patients undergoing resection of colorectal cancer (CRC) liver metastases; however, comparative analyses of their prognostic relevance is still lacking in the literature. The aim of the present study was to assess the predictive value of five published scoring systems in an independent patient cohort for the purpose of external validation.

Methods

A total of 281 patients underwent liver resection for CRC liver metastases at our institution between January 2002 and January 2008. The predictive value of the Nordlinger score, Memorial Sloan-Kettering Cancer Center (MSKCC) score, Iwatsuki score, Basingstoke index, and Mayo scoring system was assessed in this patient set. Furthermore, clinical and pathologic parameters included in the assessed scoring systems were analyzed by means of univariate and multivariate analyses.

Results

The disease-specific survival at 1, 3, and 5 years was 94.6%, 61.8%, and 33.7%, respectively. Of the assessed scoring systems, only the MSKCC score (P = .006) and the Iwatsuki score (P = .01) provided a statistically significant stratification of patients with regard to survival. The predictive value was particularly evident for patients grouped within the high-risk categories. None of these patients was alive at 3 years after surgery. The 3-year survival rates for high-risk patients in the remaining three scoring systems was >50%.

Conclusions

In our patient cohort, survival was only predicted by MSKCC and Iwatsuki scores. These findings highlight the importance of validating scoring systems in independent patient groups.

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References

  1. Bengmark S, Hafstrom L. The natural history of primary and secondary malignant tumors of the liver. I. The prognosis for patients with hepatic metastases from colonic and rectal carcinoma by laparotomy. Cancer. 1969;23:198–202.

    Article  CAS  PubMed  Google Scholar 

  2. Bengtsson G, Carlsson G, Hafstrom L, Jonsson PE. Natural history of patients with untreated liver metastases from colorectal cancer. Am J Surg. 1981;141:586–9.

    Article  CAS  PubMed  Google Scholar 

  3. Staib L, Link KH, Blatz A, Beger HG. Surgery of colorectal cancer: surgical morbidity and five- and ten-year results in 2400 patients—monoinstitutional experience. World J Surg. 2002;26:59–66.

    Article  PubMed  Google Scholar 

  4. Weitz J, Koch M, Debus J, et al. Colorectal cancer. Lancet. 2005;365:153–65.

    Article  PubMed  Google Scholar 

  5. Scheele J, Stang R, tendorf-Hofmann A, Paul M. Resection of colorectal liver metastases. World J Surg. 1995;19:59–71.

    Article  CAS  PubMed  Google Scholar 

  6. Jamison RL, Donohue JH, Nagorney DM, et al. Hepatic resection for metastatic colorectal cancer results in cure for some patients. Arch Surg. 1997;132:505–10.

    CAS  PubMed  Google Scholar 

  7. Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg. 2002;235:759–66.

    Article  PubMed  Google Scholar 

  8. Leonard GD, Brenner B, Kemeny NE. Neoadjuvant chemotherapy before liver resection for patients with unresectable liver metastases from colorectal carcinoma. J Clin Oncol. 2005;23:2038–48.

    Article  CAS  PubMed  Google Scholar 

  9. Khatri VP, Petrelli NJ, Belghiti J. Extending the frontiers of surgical therapy for hepatic colorectal metastases: is there a limit? J Clin Oncol. 2005;23:8490–9.

    Article  PubMed  Google Scholar 

  10. Weitz J, Koch M, Friess H, Buchler MW. Impact of volume and specialization for cancer surgery. Dig Surg. 2004;21:253–61.

    Article  PubMed  Google Scholar 

  11. Zakaria S, Donohue JH, Que FG, et al. Hepatic resection for colorectal metastases: value for risk scoring systems? Ann Surg. 2007;246:183–91.

    Article  PubMed  Google Scholar 

  12. Sobin LH, Wittekind C. UICC: TNM classification of malignant tumours. London: John Wiley & Sons; 2002.

    Google Scholar 

  13. Nordlinger B, Guiguet M, Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer. 1996;77:1254–62.

    Article  CAS  PubMed  Google Scholar 

  14. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309–18.

    Article  CAS  PubMed  Google Scholar 

  15. Iwatsuki S, Dvorchik I, Madariaga JR, et al. Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system. J Am Coll Surg. 1999;189:291–9.

    Article  CAS  PubMed  Google Scholar 

  16. Rees M, Tekkis PP, Welsh FK, O’Rourke T, John TG. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008;247:125–35.

    Article  PubMed  Google Scholar 

  17. Minagawa M, Makuuchi M, Torzilli G, et al. Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg. 2000;231:487–99.

    Article  CAS  PubMed  Google Scholar 

  18. Poston G, Adam R, Vauthey JN. Downstaging or downsizing: time for a new staging system in advanced colorectal cancer? J Clin Oncol. 2006;24:2702–6.

    Article  PubMed  Google Scholar 

  19. Van CE, Nordlinger B, Adam R, et al. Towards a pan-European consensus on the treatment of patients with colorectal liver metastases. Eur J Cancer. 2006;42:2212–21.

    Article  Google Scholar 

  20. Poston GJ, Figueras J, Giuliante F, et al. Urgent need for a new staging system in advanced colorectal cancer. J Clin Oncol. 2008;26:4828–33.

    Article  PubMed  Google Scholar 

  21. Justice AC, Covinsky KE, Berlin JA. Assessing the generalizability of prognostic information. Ann Intern Med. 1999;130:515–24.

    CAS  PubMed  Google Scholar 

  22. Francini G, Petrioli R, Lorenzini L, et al. Folinic acid and 5-fluorouracil as adjuvant chemotherapy in colon cancer. Gastroenterology. 1994;106:899–906.

    CAS  PubMed  Google Scholar 

  23. O’Connell MJ, Mailliard JA, Kahn MJ, et al. Controlled trial of fluorouracil and low-dose leucovorin given for 6 months as postoperative adjuvant therapy for colon cancer. J Clin Oncol. 1997;15:246–50.

    PubMed  Google Scholar 

  24. Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) investigators. Lancet. 1995;345:939–44.

    Article  Google Scholar 

  25. Bismuth H, Adam R, Levi F, et al. Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy. Ann Surg. 1996;224:509–20.

    Article  CAS  PubMed  Google Scholar 

  26. Lise M, Bacchetti S, Da PP, Nitti D, Pilati P. Patterns of recurrence after resection of colorectal liver metastases: prediction by models of outcome analysis. World J Surg. 2001;25:638–44.

    Article  CAS  PubMed  Google Scholar 

  27. Ueno H, Mochizuki H, Hatsuse K, Hase K, Yamamoto T. Indicators for treatment strategies of colorectal liver metastases. Ann Surg. 2000;231:59–66.

    Article  CAS  PubMed  Google Scholar 

  28. Schindl M, Wigmore SJ, Currie EJ, Laengle F, Garden OJ. Prognostic scoring in colorectal cancer liver metastases: development and validation. Arch Surg. 2005;140:183–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    Christoph Reissfelder MD, Nuh N. Rahbari MD, Moritz Koch MD, Alexis Ulrich MD, Isabel Pfeilschifter, Anke Waltert, Sascha A. Müller MD, Peter Schemmer MD, Markus W. Büchler MD & Jürgen Weitz MD, MSc

Authors
  1. Christoph Reissfelder MD
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  2. Nuh N. Rahbari MD
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  3. Moritz Koch MD
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  4. Alexis Ulrich MD
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  5. Isabel Pfeilschifter
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  6. Anke Waltert
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  7. Sascha A. Müller MD
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  8. Peter Schemmer MD
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  9. Markus W. Büchler MD
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  10. Jürgen Weitz MD, MSc
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Corresponding author

Correspondence to Jürgen Weitz MD, MSc.

Additional information

Christoph Reissfelder and Nuh N. Rahbari have contributed equally to this study.

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Reissfelder, C., Rahbari, N.N., Koch, M. et al. Validation of Prognostic Scoring Systems for Patients Undergoing Resection of Colorectal Cancer Liver Metastases. Ann Surg Oncol 16, 3279–3288 (2009). https://doi.org/10.1245/s10434-009-0654-7

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  • DOI: https://doi.org/10.1245/s10434-009-0654-7

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