Simplified Staging System for Predicting the Prognosis of Patients With Resectable Liver Metastasis

Minagawa, Masami; Yamamoto, Junji; Kosuge, Tomoo; Matsuyama, Yutaka; Miyagawa, Shinichi; Makuuchi, Masatoshi

doi:10.1001/archsurg.142.3.269

Cited by 81 publications

(80 citation statements)

References 48 publications

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“…Five-year survival in patients with the lowest scores was 66%, decreasing to only 2% in patients with the highest scores. Similar results have been observed in other scoring systems, including Risk score, the Memorial Sloan Kettering Cancer Center clinical risk score and simplified cancer staging systems [89][90][91].…”

Section: Scoring Systems In Selecting Patients With Oligometastasessupporting

confidence: 87%

Oligometastasis and oligo-recurrence: more than a mirage

Huang

2014

Radiation Oncology

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The standard treatment choice for cancer metastasis has been systemic management, including cytotoxic chemotherapy, hormonal manipulation, and targeted therapy. Emerging evidence has shown an oligometastatic state, an intermediate state between limited primary cancer and polymetastatic cancer, in which local therapy for metastatic lesions results in satisfactory survival comparable to non-metastatic disease. We provide a comprehensive introduction of evidence from experimental and clinical studies in favor of the oligometastatic phenotype, we review the efficacy and safety of surgery and stereotactic body radiotherapy in the treatment of oligometastases, and finally, we discuss the way to differentiate the oligometastatic state from polymetastasis.

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Section: Scoring Systems In Selecting Patients With Oligometastasessupporting

confidence: 87%

Oligometastasis and oligo-recurrence: more than a mirage

Huang

2014

Radiation Oncology

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“…The most cited factor was the number of liver metastases, identified by 15 different studies 11,20,[32][33][34][35][36][37]39,40,[42][43][44]46,47 as a negative prognostic factor. Only four studies 38,41,45,48 did not present it as a negative prognostic factor of survival after resection of CRLM.…”

Section: Prognostic Factorsmentioning

confidence: 99%

“…11,20,32,33,[35][36][37]39,42,[44][45][46] Nevertheless, six studies 34,38,40,41,47,48 concluded that regional lymph node metastases of primary tumor was not a significant prognostic factor for survival. This fact was supported by other studies not included in the analysis.…”

Section: Prognostic Factorsmentioning

confidence: 99%

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Prognostic Factors after Liver Resection for Colorectal Liver Metastasis

et al. 2015

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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.

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“…In the past, several clinical risk scores for the outcome of patients with CRLM have been published [7,[17][18][19][20][21][22][23][24][25]. In 1999, Fong et al described the most widely used CRS [19].…”

Section: Stratification By Clinical Risk Scorementioning

confidence: 99%

Neo-adjuvant chemotherapy followed by surgery versus surgery alone in high-risk patients with resectable colorectal liver metastases: The CHARISMA randomized multicenter clinical trial.

Stok

Verhoef

Grünhagen

2016

JCO

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Neo-adjuvant chemotherapy followed by surgery versus surgery alone in high-risk patients with resectable colorectal liver metastases: the CHARISMA randomized multicenter clinical trial AbstractBackground: Efforts to improve the outcome of liver surgery by combining curative resection with chemotherapy have failed to demonstrate definite overall survival benefit. This may partly be due to the fact that these studies often involve strict inclusion criteria. Consequently, patients with a high risk profile as characterized by Fong's Clinical Risk Score (CRS) are often underrepresented in these studies. Conceptually, this group of patients might benefit the most from chemotherapy. The present study evaluates the impact of neo-adjuvant chemotherapy in high-risk patients with primary resectable colorectal liver metastases, without extrahepatic disease. Our hypothesis is that adding neo-adjuvant chemotherapy to surgery will provide an improvement in overall survival (OS) in patients with a high-risk profile.Methods/Design: CHARISMA is a multicenter, randomized, phase III clinical trial. Patients will be randomized to either surgery alone (standard treatment, arm A) or to 6 cycles of neo-adjuvant oxaliplatin-based chemotherapy, followed by surgery (arm B). Patients must be ≥ 18 years of age with liver metastases of histologically confirmed primary colorectal carcinoma. Patients with extrahepatic metastases are excluded. Liver metastases must be deemed primarily resectable. Only patients with a CRS of 3-5 are eligible. The primary study endpoint is OS. Secondary endpoints are progression free survival (PFS), quality of life, morbidity of resection, treatment response on neo-adjuvant chemotherapy, and whether CEA levels can predict treatment response. Discussion: CHARISMA is a multicenter, randomized, phase III clinical trial that will provide an answer to the question if adding neo-adjuvant chemotherapy to surgery will improve OS in a well-defined high-risk patient group with colorectal liver metastases.Trial registration: The CHARISMA is registered at European Union Clinical Trials Register (EudraCT), number: 2013-004952-39, and in the "Netherlands national Trial Register (NTR), number: 4893.

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Simplified Staging System for Predicting the Prognosis of Patients With Resectable Liver Metastasis

Cited by 81 publications

References 48 publications

Oligometastasis and oligo-recurrence: more than a mirage

Oligometastasis and oligo-recurrence: more than a mirage

Prognostic Factors after Liver Resection for Colorectal Liver Metastasis

Neo-adjuvant chemotherapy followed by surgery versus surgery alone in high-risk patients with resectable colorectal liver metastases: The CHARISMA randomized multicenter clinical trial.

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