Prognostic Factors after Liver Resection for Colorectal Liver Metastasis

Abstract

Introduction: Surgery is the only potentially curative treatment for patients with colorectal liver metastases, resulting in 5-year survival rates of 36-58%. Although many studies have been performed to determine prognostic factors for tumor recurrence and survival after resection of colorectal liver metastases, there are few prognostic scoring systems stratifying patients undergoing surgery for colorectal liver metastases into risk group models. Objectives: To identify, evaluate and compare the existing prognostic scores for survival after surgery for resection of colorectal liver metastases. Material and Methods:Electronic search in PubMed, Cochrane and Embase from 1990 to 2013 using the terms 'hepatic resection', 'colorectal cancer', 'liver metastasis', 'hepatectomy', 'prognostic', and 'score'. Only studies proposing a prognostic model or risk stratification based on clinical and/or pathological variables were included. Results: From 1996 to June 2013, 19 scoring systems were identified, including one nomogram. Thirty prognostic factors were identified although none of the factors was common to all prognostic models. The 4 factors most often included were: number of liver metastases, regional lymph node metastization of primary tumor, preoperative CEA level and maximum size of metastases. The median study sample size was 305 patients (81-1 568 patients) and median follow-up was 33 months (16-54 months). All studies were retrospective and used the Cox proportional hazards model for multi-variable analysis. Conclusion: Several factors have been constantly reported as having prognostic value after liver resection of colorectal liver metastases, although there is no consensus on the ideal scoring system.

mRNA expression profiles of colorectal liver metastases as a novel biomarker for early recurrence after partial hepatectomy

“…Clinicopathological features of both patient groups (with recurrences ≤12 months and without recurrences and a DFS ≥36 months) are outlined in Table 1. The groups were homogeneous in terms of clinicopathological characteristics, as expected since all patients were selected to have a low CRS according to Fong (Matias et al., 2015). There was no difference in tumour differentiation, histological growth pattern and inflammation (at the leading edge of the tumour).…”

“…In the present study, mRNA expression profiles in CRLM were objectified in low risk patients who underwent hepatectomy with curative intent, without (neo‐) adjuvant chemotherapy. All patients were homogeneous in terms of clinical risk, as defined by current standards (Matias et al., 2015). Within this homogeneous group with respect to clinical risk, we were still able to select two opposite ends of the clinical spectrum: patients with recurrences within 12 months after surgery and patients without recurrences for at least 36 months post‐surgery.…”

“…Such prognostic biomarkers may allow a more personalised treatment strategy. In recent years, several clinicopathological prognostic variables in patients with isolated colorectal liver metastases (CRLM) have been identified predicting the risk of relapse after a metastasectomy (Matias et al., 2015). These variables have been integrated in various clinical risk scores (CRS) (Matias et al., 2015; Fong et al., 1999; Konopke et al., 2009; Nagashima et al., 2004; Nordlinger et al., 1996).…”

“…In recent years, several clinicopathological prognostic variables in patients with isolated colorectal liver metastases (CRLM) have been identified predicting the risk of relapse after a metastasectomy (Matias et al, 2015). These variables have been integrated in various clinical risk scores (CRS) (Matias et al, 2015;Fong et al, 1999;Konopke et al, 2009;Nagashima et al, 2004;Nordlinger et al, 1996). The CRS according to Fong et al is the most widely used and validated score, able to distinguish between high risk and low risk patients in terms of survival outcomes (Fong et al, 1999).…”

A new strategy based on fluorodeoxyglucose‐positron emission tomography for managing liver metastasis from colorectal cancer

“…Therefore, prognostic factors are needed to establish a new strategy that incorporates hepatectomy for improving the prognosis of patients with CRLM. Various studies have proposed postoperative prognostic factors for CRLM, such as tumor number, tumor size, age, neutrophil‐lymphocyte ratio, invasion depth of the primary colorectal lesion, and lymphatic metastasis . Other reports have described prognostic models based on calculus or nomograms using these prognostic factors, although these models have not been broadly adopted in the clinical setting.…”