Proposal of Two Prognostic Models for the Prediction of 10-Year Survival after Liver Resection for Colorectal Metastases

Abstract

Background One-third of 5-year survivors after liver resection for colorectal liver metastases (CLM) develop recurrence or tumor-related death. Therefore 10-year survival appears more adequate in defining permanent cure. The aim of this study was to develop prognostic models for the prediction of 10-year survival after liver resection for colorectal liver metastases. Methods N=965 cases of liver resection for CLM were retrospectively analyzed using univariable and multivariable regression analyses. Receiver operating curve analyses were used to assess the sensitivity and specificity of developed prognostic models and their potential clinical usefulness. Results The 10-year survival rate was 15.2%. Age at liver resection, application of chemotherapies of the primary tumor, preoperative Quick's value, hemoglobin level, and grading of the primary colorectal tumor were independent significant predictors for 10-year patient survival. The generated formula to predict 10-year survival based on these preoperative factors displayed an area under the receiver operating curve (AUROC) of 0.716. In regard to perioperative variables, the distance of resection margins and performance of right segmental liver resection were additional independent predictors for 10-year survival. The logit link formula generated with pre- and perioperative variables showed an AUROC of 0.761. Conclusion Both prognostic models are potentially clinically useful (AUROCs >0.700) for the prediction of 10-year survival. External validation is required prior to the introduction of these models in clinical patient counselling.

Predicting 10-year survival after resection of colorectal liver metastases; an international study including biomarkers and perioperative treatment

“…In a meta-analysis of eleven studies, together representing 2387 patients, the estimated 10-year OS ranged from 12% to 37% [3]. Two published prognostic models predicted 10-year OS, but considered only a small subset of all known prognostic factors [2,4]. Moreover, both models were developed using logistic regression analyses, which introduced bias by excluding patients lost to follow-up before 10-years.…”

Predictors of long‐term survival in patients with hepatic resection of colorectal metastases: Analysis of a Brazilian Cancer Center Cohort

“…The recent introduction of systemic therapy improvement and adequate surgical therapy have provided the opportunity to evaluate long‐term outcomes, possible relapses, and treatment success. Some studies have attempted to define and predict remission in colorectal metastatic patients to standardize patient selection for surgical treatment 4,19‐21 . However, no predictive models are validated to date, and multimodality treatment with surgical resection is still the standard therapy.…”

“…Some studies have attempted to define and predict remission in colorectal metastatic patients to standardize patient selection for surgical treatment. 4,[19][20][21] However, no predictive models are validated to date, and multimodality treatment with surgical resection is still the standard therapy.…”

“…4 CEA at diagnosis of primary tumor-median (IQR) 18. 19 Our study aimed to analyze prognostic factors associated with 5-and 10-year survival rates simultaneously, in a Brazilian population treated with curative intent for colorectal liver metastases.…”

Colorectal Cancer Liver Metastases: Genomics and Biomarkers with Focus on Local Therapies

“…Randomized controlled trials (RCTs) typically report five-year OS, but the evidence does not support the notion that resection is curative. Following CRLM resection, the 5- and 10-year survival was 50% and 25%, respectively [ 112 , 113 , 114 ].…”