The rate of false-positive diagnosis of colorectal liver metastases in patients undergoing resection with the development of a novel, externally validated risk score.

Autor: O'Reilly DJ; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Cardiff Liver Unit, Cardiff and Vale University Health Board, Cardiff, Wales. Electronic address: djoreilly@doctors.org.uk., Hodson J; Institute of Translational Medicine, Birmingham Health Partners, Birmigham, UK., Pike TW; Hepatobiliary Surgery Unit, St James's University Hospital, Leeds, UK., Marudanayagam R; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Sutcliffe RP; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Muiesan P; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Isaac J; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., A Lodge JP; Hepatobiliary Surgery Unit, St James's University Hospital, Leeds, UK., Mirza DF; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., Roberts KJ; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2018 Aug; Vol. 164 (2), pp. 238-243. Date of Electronic Publication: 2018 May 08.
DOI: 10.1016/j.surg.2018.02.010
Abstrakt: Background: Diagnostic error in patients undergoing resection of colorectal liver metastases (CRLM) is unusual but exposes patients to unnecessary risks associated with treatment. The primary aim of this study was to determine the rate of and risk factors for a false-positive diagnosis of colorectal liver metastases in patients undergoing hepatic resection. The secondary aim was to develop and validate a risk score to predict a false-positive diagnosis.
Methods: Patients were identified from prospectively maintained databases. Patients who underwent a first liver resection for presumed colorectal liver metastases were divided into 2 groups: CRLM POS (colorectal liver metastases present on histology or appearance of complete pathologic response to preoperative chemotherapy) and CRLM NEG (all others). Univariable analysis and multivariable binary logistic regression were used to identify risk factors for CRLM NEG . Risk scores were developed for CRLM NEG both with and without the use of preoperative carcinoembryonic antigen and were validated on an external cohort.
Results: 3.1% of patients in both test and validation cohorts were CRLM NEG (39/1,252 and 59/1,900, respectively). CRLM NEG patients had fewer (P = .006) and smaller lesions (P < .001) with lower serum levels of carcinoembryonic antigen (P < .001), T (P = .031) and N (P < .001) and a lower Dukes' stage of the primary (P < .001). The risk score performed well (area under the receiver operating characteristic curve 0.869; standard error = 0.030; P < .001) with reasonable performance on validation (area under receiver operating characteristic curve 0.743; standard error = 0.058; P < .001]).
Conclusion: A false-positive diagnosis of colorectal liver metastases affected the same proportion of patients in 2 unrelated cohorts. This study identified risk factors for false-positive diagnosis with development of a novel risk score supported by external validation.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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