World Journal of Surgery

, 35:2275 | Cite as

External Validation of Two Nomograms for Predicting Patient Survival After Hepatic Resection for Metastatic Colorectal Cancer

  • Yuji TakakuraEmail author
  • Masazumi Okajima
  • Yukihide Kanemitsu
  • Shintaro Kuroda
  • Hiroyuki Egi
  • Takao Hinoi
  • Hirotaka Tashiro
  • Hideki Ohdan



Two nomograms are available for predicting patient survival after hepatic resection for metastatic colorectal cancer (CRC). However, they have not been externally validated using other databases, and so their universal applicability has not been established. We aimed to examine the validity of these nomograms for predicting patient survival after hepatic resection for metastatic CRC in different institutions.


We analyzed the cases of 113 patients who underwent hepatic resection for metastatic CRC at Hiroshima University Hospital between 1995 and 2006. In this patient set, we assessed the predictive value of the Kattan nomogram of the Memorial Sloan-Kettering Cancer Center (MSKCC) (United States) and the Kanemitsu nomogram from the Aichi Cancer Center (Japan). The concordance index was used as an accuracy measure for comparing these two nomograms. The predictive accuracy of these nomograms was compared with that of conventional predictive models.


The 3-, 5-, and 10-year overall survival rates in our cohort were 66.3%, 52.4%, and 42.7%, respectively. The concordance indexes of the pre- and postoperative Kanemitsu nomogram and that of the Kattan nomogram were 0.70, 0.69, and 0.68, respectively. These values were higher than those obtained using other models for hepatic metastatic CRC, including the clinical risk score of the MSKCC and the grading system of the Japanese Society for Cancer of the Colon and Rectum.


The high predictive accuracy of both nomograms shows that these predictive tools can be used in different institutions. Patient counseling and adjuvant therapy decision-making should benefit from use of these nomograms.


Hepatic Resection Colorectal Liver Metastasis Extrahepatic Disease Clinical Risk Score Abdominal Compute Tomography Scan 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

The authors have no commercial associations that might pose a conflict of interest in connection with the submitted article.


  1. 1.
    Benoist S, Nordlinger B (2009) The role of preoperative chemotherapy in patients with resectable colorectal liver metastases. Ann Surg Oncol 16:2385–2390PubMedCrossRefGoogle Scholar
  2. 2.
    Nordlinger B, Sorbye H, Glimelius B et al (2008) Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup Trial 40983): a randomised controlled trial. Lancet 371:1007–1016PubMedCrossRefGoogle Scholar
  3. 3.
    Iwatsuki S, Dvorchik I, Madariaga JR et al (1999) Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system. J Am Coll Surg 189:291–299PubMedCrossRefGoogle Scholar
  4. 4.
    Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318 (discussion 318–321)PubMedCrossRefGoogle Scholar
  5. 5.
    Rees M, Tekkis PP, Welsh FK et al (2008) Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg 247:125–135PubMedCrossRefGoogle Scholar
  6. 6.
    Nordlinger B, Guiguet M, Vaillant JC et al (1996) 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 77:1254–1262PubMedCrossRefGoogle Scholar
  7. 7.
    Minagawa M, Yamamoto J, Kosuge T et al (2007) Simplified staging system for predicting the prognosis of patients with resectable liver metastasis: development and validation. Arch Surg 142:269–276 (discussion 277)PubMedCrossRefGoogle Scholar
  8. 8.
    Mala T, Bohler G, Mathisen O et al (2002) Hepatic resection for colorectal metastases: can preoperative scoring predict patient outcome? World J Surg 26:1348–1353. doi: 10.1007/s00268-002-6231-x PubMedCrossRefGoogle Scholar
  9. 9.
    Merkel S, Bialecki D, Meyer T et al (2009) Comparison of clinical risk scores predicting prognosis after resection of colorectal liver metastases. J Surg Oncol 100:349–357PubMedCrossRefGoogle Scholar
  10. 10.
    Mann CD, Metcalfe MS, Leopardi LN et al (2004) The clinical risk score: emerging as a reliable preoperative prognostic index in hepatectomy for colorectal metastases. Arch Surg 139:1168–1172PubMedCrossRefGoogle Scholar
  11. 11.
    Yamaguchi T, Mori T, Takahashi K et al (2008) A new classification system for liver metastases from colorectal cancer in Japanese multicenter analysis. Hepatogastroenterology 55:173–178PubMedGoogle Scholar
  12. 12.
    Kattan MW, Heller G, Brennan MF (2003) A competing-risks nomogram for sarcoma-specific death following local recurrence. Stat Med 22:3515–3525PubMedCrossRefGoogle Scholar
  13. 13.
    Kattan MW, Karpeh MS, Mazumdar M et al (2003) Postoperative nomogram for disease-specific survival after an R0 resection for gastric carcinoma. J Clin Oncol 21:3647–3650PubMedCrossRefGoogle Scholar
  14. 14.
    Brennan MF, Kattan MW, Klimstra D et al (2004) Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg 240:293–298PubMedCrossRefGoogle Scholar
  15. 15.
    Cagiannos I, Karakiewicz P, Eastham JA et al (2003) A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer. J Urol 170:1798–1803PubMedCrossRefGoogle Scholar
  16. 16.
    Diblasio CJ, Kattan MW (2003) Use of nomograms to predict the risk of disease recurrence after definitive local therapy for prostate cancer. Urology 62(Suppl 1):9–18PubMedCrossRefGoogle Scholar
  17. 17.
    Kattan MW (2003) Nomograms are superior to staging and risk grouping systems for identifying high-risk patients: preoperative application in prostate cancer. Curr Opin Urol 13:111–116PubMedCrossRefGoogle Scholar
  18. 18.
    Kattan MW, Zelefsky MJ, Kupelian PA et al (2003) Pretreatment nomogram that predicts 5-year probability of metastasis following three-dimensional conformal radiation therapy for localized prostate cancer. J Clin Oncol 21:4568–4571PubMedCrossRefGoogle Scholar
  19. 19.
    Kattan MW, Reuter V, Motzer RJ et al (2001) A postoperative prognostic nomogram for renal cell carcinoma. J Urol 166:63–67PubMedCrossRefGoogle Scholar
  20. 20.
    Van Zee KJ, Manasseh DM, Bevilacqua JL et al (2003) A nomogram for predicting the likelihood of additional nodal metastases in breast cancer patients with a positive sentinel node biopsy. Ann Surg Oncol 10:1140–1151PubMedCrossRefGoogle Scholar
  21. 21.
    Kattan MW, Gonen M, Jarnagin WR et al (2008) A nomogram for predicting disease-specific survival after hepatic resection for metastatic colorectal cancer. Ann Surg 247:282–287PubMedCrossRefGoogle Scholar
  22. 22.
    Kanemitsu Y, Kato T (2008) Prognostic models for predicting death after hepatectomy in individuals with hepatic metastases from colorectal cancer. World J Surg 32:1097–1107. doi: 10.1007/s00268-007-9348-0 PubMedCrossRefGoogle Scholar
  23. 23.
    Giacchetti S, Itzhaki M, Gruia G et al (1999) Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery. Ann Oncol 10:663–669PubMedCrossRefGoogle Scholar
  24. 24.
    Simmonds PC, Primrose JN, Colquitt JL et al (2006) Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 94:982–999PubMedCrossRefGoogle Scholar
  25. 25.
    De Jong MC, Mayo SC, Pulitano C et al (2009) Repeat curative intent liver surgery is safe and effective for recurrent colorectal liver metastasis: results from an international multi-institutional analysis. J Gastrointest Surg 13:2141–2151PubMedCrossRefGoogle Scholar
  26. 26.
    Van Cutsem E, Rivera F, Berry S et al (2009) Safety and efficacy of first-line bevacizumab with FOLFOX, XELOX, FOLFIRI and fluoropyrimidines in metastatic colorectal cancer: the BEAT study. Ann Oncol 20:1842–1847PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Yuji Takakura
    • 1
    Email author
  • Masazumi Okajima
    • 2
  • Yukihide Kanemitsu
    • 3
  • Shintaro Kuroda
    • 1
  • Hiroyuki Egi
    • 1
  • Takao Hinoi
    • 1
  • Hirotaka Tashiro
    • 1
  • Hideki Ohdan
    • 1
  1. 1.Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical ScienceHiroshima UniversityHiroshimaJapan
  2. 2.Department of Endoscopic Surgery and Surgical Science, Graduate School of Biomedical ScienceHiroshima UniversityHiroshimaJapan
  3. 3.Department of Gastroenterological SurgeryAichi Cancer Center HospitalNagoyaJapan

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