Nontumor related risk score: A new tool to improve prediction of prognosis after hepatectomy for colorectal liver metastases.

Autor: Sasaki K; Department of Surgery, Stanford University School of Medicine, Stanford, CA. Electronic address: sasakik@stanford.edu., Margonis GA; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Department of General, Visceral and Vascular Surgery, Charite Campus Benjamin Franklin, Berlin, Germany., Moro A; Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH., Wang J; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Wagner D; Department of General Surgery, Medical University of Graz, Graz, Austria., Gagnière J; Service de Chirurgie Digestive, CHU Clermont-Ferrand, Inserm, Université Clermont, Clermont-Ferrand, France., Shin JK; Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., D'Silva M; Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea., Sahara K; Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan., Miyata T; Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, Kumamoto, Japan., Kusakabe J; Department of Surgery, Stanford University School of Medicine, Stanford, CA., Beyer K; Department of General, Visceral and Vascular Surgery, Charite Campus Benjamin Franklin, Berlin, Germany., Dupré A; Service de Chirurgie Digestive, CHU Clermont-Ferrand, Inserm, Université Clermont, Clermont-Ferrand, France., Kamphues C; Department of General, Visceral and Vascular Surgery, Charite Campus Benjamin Franklin, Berlin, Germany., Imai K; Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, Kumamoto, Japan., Baba H; Department of Gastroenterological Surgery, Graduate School of Life Sciences Kumamoto University, Kumamoto, Japan., Endo I; Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan., Taura K; Department of Gastroenterological Surgery, Kyoto University Hospital, Kyoto, Japan., Cho JY; Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea., Aucejo F; Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH., Kornprat P; Department of General Surgery, Medical University of Graz, Graz, Austria., Kreis ME; Department of General, Visceral and Vascular Surgery, Charite Campus Benjamin Franklin, Berlin, Germany., Kim JM; Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., Burkhart R; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., David Kwon CH; Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH., Pawlik TM; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: https://twitter.com/timpawlik.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2022 Jun; Vol. 171 (6), pp. 1580-1587. Date of Electronic Publication: 2022 Feb 25.
DOI: 10.1016/j.surg.2022.01.030
Abstrakt: Background: Prognostic stratification of patients with colorectal cancer liver metastasis based solely on tumor-related factors has only moderate discriminatory ability. We hypothesized that the inclusion of nontumor related factors can improve prediction of long-term prognosis of patients with colorectal cancer liver metastasis.
Methods: Nontumor related laboratory markers were assessed utilizing a training cohort from 2 U.S. institutions (n = 1,205). Factors independently associated with prognosis were used to develop a nontumor related prognostic score. The discriminatory ability, assessed by Harrell's C-statistics (C-index) and net reclassification improvement, was validated and compared with 3 commonly used tumor-related clinical risk scores: Fong clinical risk scores, m-clinical risk scores, and Genetic and Morphological Evaluation (GAME) score in an external validation cohort from 5 Asian (n = 1,307) and 3 European (n = 1,058) institutions. The discriminatory ability of nontumor related prognostic score combined with each of these 3 tumor-related prognostic scores was also estimated.
Results: Alkaline phosphatase (hazard ratio 1.43; 95% confidence interval, 1.11-1.84), albumin (hazard ratio 0.71; 95% confidence interval, 0.57-0.89), and mean corpuscular volume (hazard ratio 19.0, per log unit; 95% confidence interval, 4.79-75.0) were each independently associated with increased risk of death after resection of colorectal cancer liver metastasis (all P < .05). In turn, alkaline phosphatase, albumin, and mean corpuscular volume were combined to form a nontumor related prognostic score (2.942 × mean corpuscular volume + 0.399 × alkaline phosphatase-0.339 × albumin-12) × 10 (median, 16; range, 1-30). The nontumor related prognostic score had good-to-modest discriminatory ability in the external cohort (C-index = 0.58), which was comparable to the 3 established tumor-related prognostic scores (C-index: Fong clinical risk scores, 0.53, m-clinical risk scores, 0.55, GAME, 0.58). The addition of the nontumor related prognostic score to the tumor-related prognostic scores enhanced the discriminatory ability in the entire study cohort (C-index: nontumor related score+Fong, 0.60, nontumor related score+m-clinical risk scores, 0.61, nontumor related score+GAME, 0.64), as well reclassification improvement (42.5, 42.7%, and 21.2%, respectively).
Conclusion: Nontumor related prognostic information may help improve the prognostic stratification of patients after resection of colorectal cancer liver metastasis. The nontumor related prognostic score may be combined with tumor-related prognostic tools to enhance prognostic stratification of patients with colorectal cancer liver metastasis.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: