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Accuracy of Modern Clinical Risk Score Including RAS Status Changes Based on Whether Patients Received Perioperative Chemotherapy for Colorectal Liver Metastases

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Abstract

Background

A modified Fong clinical score (m-Fong CS) that includes the RAS mutation status has recently been proposed and offered an improved survival stratification of patients who undergo surgery and systemic chemotherapy for colorectal liver metastases (CLM). The aim of this study is to assess whether a CS that includes RAS status is influenced by whether patients receive perioperative chemotherapy.

Methods

We created a new CS using multivariate analysis of data of patients who underwent hepatectomy for CLM for the first time between 2010 and 2016 at a single hospital (n = 341, 79% received perioperative chemotherapy). The resulting CS and m-Fong CS were then validated in the patient cohort at three other hospitals (n = 309). Furthermore, the applicability of the two CS in the total cohort (n = 650) was tested according to whether the patients received perioperative chemotherapy.

Results

The new CS comprised mutant RAS status, ≥4 CLMs, and a CA19-9 level ≥100 U/mL (1 point per factor). Both the new CS and m-Fong CS failed to stratify the survival of the 309 patients in the validation cohort, including those who did not receive perioperative chemotherapy (29%). Both of the CS accurately stratified the survival of patients who underwent perioperative chemotherapy but not of those who underwent surgery alone.

Conclusion

A CS that includes the RAS mutation status can stratify the survival of patients who undergo hepatectomy combined with perioperative chemotherapy, but it has limited value for patients who undergo surgery alone.

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Ariake, Tokyo, 113-8421, Japan

    Yoshinori Takeda, Yoshihiro Mise, Yosuke Inoue, Hiromichi Ito, Yu Takahashi & Akio Saiura

  2. Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Hongo, Tokyo, Japan

    Yoshinori Takeda, Yoshihiro Mise, Jiro Yoshimoto, Hiroshi Imamura & Akio Saiura

  3. Clinical Research and Medical Development Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan

    Masaru Matsumura & Kiyoshi Hasegawa

  4. Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan

    Takuji Noro & Junji Yamamoto

  5. Clinical Research and Medical Development Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Naoki Ishizuka

Authors
  1. Yoshinori Takeda
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  2. Yoshihiro Mise
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  3. Masaru Matsumura
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  4. Kiyoshi Hasegawa
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Corresponding author

Correspondence to Akio Saiura.

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The study protocol was approved by Institutional Review Board.

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The institutional review board waived the need for informed consent to be obtained from the patients for the use of their medical records, imaging records, or pathology records.

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Takeda, Y., Mise, Y., Matsumura, M. et al. Accuracy of Modern Clinical Risk Score Including RAS Status Changes Based on Whether Patients Received Perioperative Chemotherapy for Colorectal Liver Metastases. World J Surg 45, 2176–2184 (2021). https://doi.org/10.1007/s00268-021-05976-x

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  • DOI: https://doi.org/10.1007/s00268-021-05976-x

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