Genetic And Morphological Evaluation (GAME) score for patients with colorectal liver metastases

Margonis, Georgios Antonios; Sasaki, Kazunari; Gholami, Sepideh; Kim, Y.; Andreatos, Nikolaos; Rezaee, Neda; Deshwar, Amar; Buettner, Stefan; Allen, Peter J.; Kingham, T. Peter; Pawlik, Timothy M.; He, Jin; Cameron, John L.; Jarnagin, William R.; Wolfgang, Christopher L.; D’Angelica, Michael I.; Weiss, Matthew J.

doi:10.1002/bjs.10838

Cited by 134 publications

(118 citation statements)

References 47 publications

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“…Previously, Fong et al [20] established a clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer based on clinical and morphological criteria (size and number of liver metastases), as well as CEA levels. More recently, Margonis et al [21] developed the GAME score, which presents some advantages over the FONG score. First, it is the first score to include a genetic criterion (K-RAS status).…”

Section: Fit Patients (Fig 1a)mentioning

confidence: 99%

Multidisciplinary management of liver metastases in patients with colorectal cancer: a consensus of SEOM, AEC, SEOR, SERVEI, and SEMNIM

et al. 2019

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Colorectal cancer (CRC) has the second-highest tumor incidence and is a leading cause of death by cancer. Nearly 20% of patients with CRC will have metastases at the time of diagnosis, and more than 50% of patients with CRC develop metastatic disease during the course of their disease. A group of experts from Medicine and Molecular Imaging met to discuss and provide a multidisciplinary consensus on the management of liver metastases in patients with CRC. The group defined the different scenarios in which the disease can present: fit or unfit patients with resectable liver metastases, patients with potential resectable liver metastases, and patients with unresectable liver metastases. Within each scenario, the different strategies and therapeutic approaches are discussed.

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Section: Fit Patients (Fig 1a)mentioning

confidence: 99%

Multidisciplinary management of liver metastases in patients with colorectal cancer: a consensus of SEOM, AEC, SEOR, SERVEI, and SEMNIM

et al. 2019

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“…The well established predictors of poor outcome include node‐positive primary cancer, disease‐free interval shorter than 12 months, more than one tumour, tumour size larger than 5 cm, carcinoembryonic antigen (CEA) level exceeding 200 ng/ml, bilobar liver involvement and presence of extrahepatic disease (EHD). Recently, new parameters have also been found to improve the accuracy of current prognostic systems, such as KRAS mutation status, histological growth pattern and the response to preoperative chemotherapy. However, more effective and applicable prognostic factors are still needed to build the optimal preoperative prediction system.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of the association between primary tumour location and prognosis after surgical resection of colorectal liver metastases

Wang

Zhang

Wang

et al. 2019

British Journal of Surgery

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Background Primary tumour location is emerging as an important prognostic factor in localized and metastatic colorectal cancers. However, its prognostic role in colorectal liver metastasis (CRLM) after hepatectomy remains controversial. A systematic review and meta‐analysis was undertaken to evaluate its prognostic value. Methods References were identified through searches of PubMed, Embase, Web of Science and the Cochrane Library comparing overall or disease‐free survival after hepatic resection between patients with CRLM originating from right‐ or left‐sided colorectal cancers. Data were pooled using hazard ratios (HRs) and 95 per cent confidence intervals according to a random‐effects model. Meta‐regression and subgroup analyses were conducted to assess the effect of underlying confounding factors on HR estimates and to adjust for this. Results The final analysis included 21 953 patients from 45 study cohorts. Compared with left‐sided primary tumour location, right‐sided location was associated with worse overall survival (HR 1·39, 95 per cent c.i. 1·28 to 1·51; P < 0·001; prediction interval 1·00 to 1·93), and also tended to have a negative impact on disease‐free survival (HR 1·18, 1·06 to 1·32; P = 0·004; prediction interval 0·79 to 1·75). Subgroup analysis showed that the negative effect of right‐sided primary tumour location on overall survival was more prominent in the non‐Asian population (HR 1·47, 1·33 to 1·62) than the Asian population (HR 1·18, 1·05 to 1·32) (P for interaction <0·01). Conclusion This study demonstrated a prognostic role for primary tumour location in patients with CRLM receiving hepatectomy, especially regarding overall survival. Adding primary tumour location may provide important optimization of prognosis prediction models for CRLM in current use.

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“…We constructed a Genetic and Morphological Evaluation score (i.e. GAME score) by assigning points according to the prognostic weight of the following variables: KRAS mutational status (one point), carcinoembryonic antigen level 20 ng/mL or more (one point), primary tumor lymph node metastasis (one point), Tumor Burden Score between 3 and 8 (one point) or 9 and over (two points), and extrahepatic disease (two points) . Importantly, the group with the highest GAME score (from six to seven points) had an expected survival rate of 0%.…”

Section: Resultsmentioning

confidence: 99%

Mutation status and surgical selection

Margonis

Kreis

Wolfgang

et al. 2019

Journal of Surgical Oncology

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Current evidence cannot support denying metastasectomy in otherwise resectable patients solely based on their overall KRAS or BRAF mutational status. The combination of KRAS or BRAF mutational status with certain clinicopathologic characteristics has defined groups of patients who may not derive benefit from metastasectomy, but external validation is needed. The effect of certain KRAS or BRAF variants on survival may be more pronounced and therefore future studies should consider them for surgical selection.

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Genetic And Morphological Evaluation (GAME) score for patients with colorectal liver metastases

Abstract: The GAME score is a preoperative prognostic tool that can be used to inform treatment selection.

Cited by 134 publications

References 47 publications

Multidisciplinary management of liver metastases in patients with colorectal cancer: a consensus of SEOM, AEC, SEOR, SERVEI, and SEMNIM

Multidisciplinary management of liver metastases in patients with colorectal cancer: a consensus of SEOM, AEC, SEOR, SERVEI, and SEMNIM

Meta-analysis of the association between primary tumour location and prognosis after surgical resection of colorectal liver metastases

Mutation status and surgical selection

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