The Clinical Risk Score

Abstract

The purpose of this study was to examine the validity of the clinical risk score (CRS), a prognostic tool developed by Fong et al, when translated to another center. Design: This study assesses 5 independent preoperative prognostic criteria, nodal status of the primary lesion, disease-free interval, number of hepatic metastases, size of the largest metastasis, and preoperative carcinoembryonic antigen level, to determine a preoperative CRS for each patient included in the study.

Surgery for colorectal liver metastases: The evolution of determining prognosis

“…Primary tumor stage was later incorporated into clinical prognostic scoring systems [9,10] . Specifically, Fong et al [9] proposed the stage of the primary tumor as an adverse prognostic factor, concluding that the nodal status of the primary cancer was highly predictive of outcome [9,[12][13][14][15] . A subsequent meta-analysis reported an association between primary tumor stage, nodal metastasis, and worse outcomes following resection of CRLM [13][14][15] .…”

“…The role of carcinoembryonic antigen (CEA) as a robust predictor of long-term survival following resection of CRLM remains poorly defined [9,10,12,[18][19][20][21][22] . Among many patients, CEA can be an effective marker to monitor for recurrence, as well as to assess response to systemic therapy [18,21] .…”

“…CEA levels can correlate with the radiological response to preoperative chemotherapy; however, other data have suggested that the absolute change in CEA level with chemotherapy may not correlate with long-term outcome [23] . As a pre-operative prognostic factor, Mann et al [12] reported that CEA levels did correlate with 5-year survival (CEA levels < 200 ng/mL: 48.9% vs > 200 ng/mL: 0.0%). Other studies have similarly noted that preoperative CEA > 200 ng/mL was an independent factor of poor OS and disease specific survival (DSS), respectively [18,21] .…”

“…The reason for the disparate finding from various studies may be due to the different cut-off values used for CEA, as well as differences in how the statistical models were constructed (e.g., which other competing risk factors were put into the model, how many patients in any given study had a particular factor, etc.). Scheele et al [11] P NA P NP P P P Nordlinger et al [10] P P P P P NA P Fong et al [9] P P P P P P P Mann et al [12] P P P NP NP NA NA Rees et al [15] P P P P NA P P John et al [21] NP P NP NP NA NP P Doci et al [27] P NP NP NP NP NA NA Hughes et al [34] P P P P P NA NA Gayowski et al [37] P NA NP P NP P P CEA: Carcinoembryonic antigen; P: Prognostic; NP: Non prognostic; NA: Non available.…”

“…Mann et al [12] reported that 5-year survival was 51.6% among patients undergoing surgery for CRLM ≤ 5 cm compared with 27% for those patients with a tumor > 5 cm. In other studies, patients with CRLM measuring > 5 cm were similarly noted to have a worse survival [15] .…”