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A nomogram predicting disease-free survival in patients with colorectal liver metastases treated with hepatic resection: multicenter data collection as a Project Study for Hepatic Surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery

  • Original article
  • Published:
Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background/purpose

The aim of this study was to create a nomogram to predict the disease-free survival of patients with colorectal liver metastases treated with hepatic resection.

Methods

Perioperative factors were assessed in 727 hepatectomized patients with colorectal liver metastases between 2000 and 2004 at the 11 institutions of the “Project Committee of the Liver” in the Japanese Society of Hepato-Biliary-Pancreatic Surgery. A nomogram was developed as a graphical representation of a stepwise Cox proportional hazards regression model.

Results

Perioperative mortality was 0.55%. Disease-free and overall survival rates were 31.2 and 63.8% at 3 years, 27.2 and 47.7% at 5 years, and 24.7 and 38.5% at 10 years, respectively. Six preoperative factors were selected to create the nomogram for disease-free survival: synchronous metastases, 3 points; primary lymph node positive, 3 points; number of tumors 2–4, 4 points and ≥5, 9 points; largest tumor diameter >5 cm, 2 points; extrahepatic metastasis at hepatectomy, 4 points, and preoperative carbohydrate antigen 19-9 level >100, 4 points. The estimated median disease-free survival time was easily calculated by the nomogram: >8.4 years for patients with 0 points, 1.9 years for 5 points, 1.0 years for 10 points, and the rates were lower than 0.6 years for patients with more than 10 points.

Conclusions

This nomogram can easily calculate the median and yearly disease-free survival rates from only 6 preoperative variables. This is a very useful tool to determine the likelihood of early recurrence and the necessity for perioperative chemotherapy in patients with colorectal liver metastases after hepatic resection.

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Abbreviations

CRLM:

Colorectal liver metastases

OS:

Overall survival

DFS:

Disease-free survival

FOLFOX:

Chemotherapy with oxaliplatin plus fluorouracil and leucovorin

FOLFIRI:

Chemotherapy with irinotecan plus fluorouracil and leucovorin

CI:

Confidence interval

HR:

Hazard ratio

BMI:

Body mass index

LN:

Lymph node

CEA:

Carcinoembryonic antigen

CA19-9:

Carbohydrate antigen 19-9

Hr1:

One sectionectomy

RCC:

Red cell concentrate

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Acknowledgments

The authors give special thanks to Dr. Hirohisa Okabe for his tremendous contribution to analysis of the database.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Social and Cultural Sciences, Kumamoto University, Kumamoto, Japan

    Toru Beppu & Hideo Baba

  2. Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan

    Yoshihiro Sakamoto & Tomoo Kosuge

  3. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Kiyoshi Hasegawa & Norihiro Kokudo

  4. Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    Goro Honda & Keiichi Takahashi

  5. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Kuniya Tanaka & Itaru Endo

  6. Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawadacho, Shinjyukuku, Tokyo, 162-8666, Japan

    Yoshihito Kotera & Masakazu Yamamoto

  7. Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan

    Hiroyuki Nitta & Go Wakabayashi

  8. Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan

    Hiroyuki Yoshidome & Masaru Miyazaki

  9. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Etsuro Hatano & Shinji Uemoto

  10. Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan

    Masaki Ueno & Hiroki Yamaue

  11. Department of Gastroenterological Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan

    Hiroyuki Takamura & Tetsuo Ohta

  12. Medical Quality Management Center, Graduate School of Social and Cultural Sciences, Kumamoto University, Kumamoto, Japan

    Ken Kikuchi

  13. Japanese Society of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan

    Tadahiro Takada

Authors
  1. Toru Beppu
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  16. Itaru Endo
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  17. Go Wakabayashi
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  18. Masaru Miyazaki
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  19. Shinji Uemoto
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  22. Hiroki Yamaue
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Corresponding author

Correspondence to Masakazu Yamamoto.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Electronic supplementary Figure: Instructions for physician: Click the bottom of “status” in “Preoperative Score” and choose the individual status of 6 parameters. You can instantly find not only the patient’s estimated disease-free survival curve but also the median and the rates of disease-free survival at 3 and 5 years.

Supplementary material 1 (XLSX 60 kb)

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Beppu, T., Sakamoto, Y., Hasegawa, K. et al. A nomogram predicting disease-free survival in patients with colorectal liver metastases treated with hepatic resection: multicenter data collection as a Project Study for Hepatic Surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci 19, 72–84 (2012). https://doi.org/10.1007/s00534-011-0460-z

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