Indication for neoadjuvant chemotherapy in patients with colorectal liver metastases based on a nomogram that predicts disease-free survival

Okuno, Masayuki; Hatano, Etsuro; Seo, Satoru; Taura, Kojiro; Yasuchika, Kentaro; Nakajima, Akira; Yazawa, Takefumi; Furuyama, Hiroaki; Kawamoto, Hiroshi; Yagi, Shintaro; Nishitai, Ryuta; Fujikawa, Takahisa; Arimoto, Akira; Zaima, Masazumi; Yoshimura, Tsunehiro; Terajima, Hiroaki; Kaihara, Satoshi; Manaka, Dai; Üemoto, Shinji

doi:10.1002/jhbp.149

Cited by 17 publications

(21 citation statements)

References 23 publications

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“…Regarding the independent prognostic factors in the nomograms, non-R0 resection and primary lymph node metastasis were found to be associated with poor OS and PFS, which was consistent with the findings of previous studies (7,8,24). Some nomograms have been developed to predict individual survival probabilities for CRLM patients receiving NAC (7,8,11), but the present nomograms have some unique features. First, TRG was incorporated into the nomogram for predicting PFS.…”

Section: Discussionsupporting

confidence: 88%

“…Nomograms provide a graphical representation of a predictive model and are used to generate a numerical probability of a clinical event and are thus helpful for formulating reasonable clinical strategies early in CRLM patient management. However, only a few studies (7,8,11) have developed a nomogram for CRLM patients who received NAC followed by hepatic resection, and the previous nomograms are lacking in several ways. First, these nomograms did not consider the influence of NAC-related factors [e.g., tumour regression grade (TRG), NAC toxicity] or preoperative testing markers [e.g., gamma-glutamyl transpeptidase (GGT), D-dimer] on prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Upgraded nomograms for the prediction of complications and survival in patients with colorectal liver metastases treated with neoadjuvant chemotherapy followed by hepatic resection

et al. 2021

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Background: To establish upgraded nomograms incorporating neoadjuvant chemotherapy (NAC)-related factors and preoperative testing markers to predict postoperative complications, progression-free survival (PFS) and overall survival (OS) in patients with colorectal liver metastases (CRLM).Methods: Multivariate regression analyses were used to reveal independent predictors for postoperative complications, PFS and OS. Nomograms incorporating independent predictors were constructed, and discrimination and calibration were evaluated. Survival was estimated by the Kaplan-Meier method and compared using the log-rank test.Results: A nomogram predicting postoperative complications was constructed based on preoperative serum gamma-glutamyl transpeptidase (GGT) ≥36 U/L, major liver resection, intraoperative blood loss ≥300 mL, primary site located in the right hemicolon and primary lymph node metastasis, with an area under the receiver operating characteristic curve (AUROC) of 0.750. The calibration curves and Hosmer-Lemeshow test revealed desirable model calibration (chi-square: 4.47, P=0.88). Moreover, a nomogram for the prediction of PFS was constructed based on tumour regression grade (TRG), primary lymph node metastasis, R0 resection and NAC cycles ≥5, with good discrimination (C-index: 0.663±0.024) and calibration, and one for predicting OS was constructed based on preoperative GGT ≥36 U/L, NAC toxicity, NAC cycles ≥5, primary lymph node metastasis and R0 resection, with favourable discrimination (C-index: 0.684±0.030) and calibration. Significant differences in PFS and OS were observed among patients stratified into three different risk groups (P<0.001) according to total scores based on the nomograms.Conclusions: This study is the first to establish novel predictive nomograms specifically incorporating TRG, NAC toxicity and serum GGT level for the prediction of postoperative complications, PFS and OS in CRLM patients. The nomograms exhibit favourable discrimination and calibration to guide personalized CRLM management and therapy.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Upgraded nomograms for the prediction of complications and survival in patients with colorectal liver metastases treated with neoadjuvant chemotherapy followed by hepatic resection

et al. 2021

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“…In contrast to those aiming at early stages that have shown higher accuracy, nomograms for recurrence after curative surgery in CRLM patients with usability and accuracy have not been satisfactory due to the complexity of CRLMs [ 7 , 17 , 28 , 48 , 49 ]. Our nomogram yielded an AUC of 0.866 and 0.792 for internal and external validation, respectively.…”

Section: Discussionmentioning

confidence: 99%

A predictive model for early recurrence of colorectal-cancer liver metastases based on clinical parameters

Dai

Yao

Kong

et al. 2021

Gastroenterology Report

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Background The prognosis for patients with colorectal-cancer liver metastases (CRLM) after curative surgery remains poor and shows great heterogeneity. Early recurrence, defined as tumor recurrence within 6 months of curative surgery, is associated with poor survival, requiring earlier detection and intervention. This study aimed to develop and validate a bedside model based on clinical parameters to predict early recurrence in CRLM patients and provide insight into post-operative surveillance strategies. Material and methods A total of 202 consecutive CRLM patients undergoing curative surgeries between 2012 and 2019 were retrospectively enrolled and randomly assigned to the training (n = 150) and validation (n = 52) sets. Baseline information and radiological, pathological, and laboratory findings were extracted from medical records. Predictive factors for early recurrence were identified via a multivariate logistic-regression model to develop a predictive nomogram, which was validated for discrimination, calibration, and clinical application. Results Liver-metastases number, lymph-node suspicion, neurovascular invasion, colon/rectum location, albumin and post-operative carcinoembryonic antigen, and carbohydrate antigen 19–9 levels (CA19–9) were independent predictive factors and were used to construct the nomogram for early recurrence after curative surgery. The area under the curve was 0.866 and 0.792 for internal and external validation, respectively. The model significantly outperformed the clinical risk score and Beppu’s model in our data set. In the lift curve, the nomogram boosted the detection rate in post-operative surveillance by two-fold in the top 30% high-risk patients. Conclusion Our model for early recurrence in CRLM patients after curative surgeries showed superior performance and could aid in the decision-making for selective follow-up strategies.

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“…Several reports have described the relationship between Beppu's nomogram score and DFS. For example, Okuno et al (21) reported that Beppu's nomogram score is a marker of poor DFS. Two hundred and thirty-four patients with colorectal liver metastases who underwent hepatic resection were evaluated using Beppu's nomogram.…”

Section: Discussionmentioning

confidence: 99%

Beppu's Nomogram Score Is an Independent Prognostic Factor for Colorectal Liver Metastasis Receiving Perioperative Chemotherapy and/or Targeted Therapy

Higuchi

Aoyama

Kazama

et al. 2019

In Vivo

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Background/Aim: We investigated the impact of Beppu's nomogram on colorectal liver metastasis in patients receiving perioperative chemotherapy and/or targeted therapy. Patients and Methods: This study included 43 patients who underwent primary hepatic resection for colorectal liver metastasis at the Kanagawa Cancer Center from June 2006 to March 2011. The patients were classified as having a Beppu's nomogram score ≤9 (low-risk group) or ≥10 (high-risk group). The risk factors for the disease-free survival (DFS) were identified. Results: The respective DFS rates at 1, 2, and 3 years after surgery were 72.0%, 43.3%, and 17.3% in the low-risk group and 27.8%, 16.7%, and 8.3% in the high-risk group, the difference being significant (p=0.009). The multivariate analysis showed that Beppu's nomogram score ≥10 was a significant independent risk factor for the DFS. Conclusion: Beppu's nomogram score was an independent prognostic factor for colorectal liver metastasis in patients receiving perioperative chemotherapy and/or targeted therapy. Thus, Beppu's nomogram might be a useful tool for predicting the risk of recurrence after hepatectomy, even in the era of newly-developed chemotherapy.

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Indication for neoadjuvant chemotherapy in patients with colorectal liver metastases based on a nomogram that predicts disease-free survival

Abstract: The nomogram validation was shown to be moderately predictive. PHC decreased the performance of the nomogram and might produce no DFS benefit in patients with low recurrent risk.

Cited by 17 publications

References 23 publications

Upgraded nomograms for the prediction of complications and survival in patients with colorectal liver metastases treated with neoadjuvant chemotherapy followed by hepatic resection

Upgraded nomograms for the prediction of complications and survival in patients with colorectal liver metastases treated with neoadjuvant chemotherapy followed by hepatic resection

A predictive model for early recurrence of colorectal-cancer liver metastases based on clinical parameters

Beppu's Nomogram Score Is an Independent Prognostic Factor for Colorectal Liver Metastasis Receiving Perioperative Chemotherapy and/or Targeted Therapy

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