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

Abstract

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.

Nomogram Incorporating Preoperative Testing Markers for the prediction of Early Recurrence for Colorectal Liver Metastases with Neoadjuvant Chemotherapy followed by Hepatectomy

“…As described previously [22], NAC was recommended to patients with one or more factors that are considered to increase the risk of recurrence, including primary lymph node metastasis at diagnosis, synchronous presentation of the primary tumor and liver metastases, and more than one liver lesion. The chemotherapy regimens were FOLFOX (5-flurouracil, leucovorin, and oxaliplatin), FOLFIRI (5-flurouracil, leucovorin, and irinotecan), or XELOX (capecitabine and oxaliplatin), with or without bevacizumab or cetuximab.…”

“…As described previously, patients were followed up at regular intervals after surgery [22]. The first follow-up was done 1 month after hepatectomy.…”

“…Nomograms are reliable and convenient tools of predicting hazards and facilitate clinical decision-making in CRLM management. Several nomograms were already established to predict the prognosis of CRLM patients with curative surgery after NAC [15,[20][21][22]. However, these established nomograms focused on predicting postoperative complications or survival, and nomograms focusing on the prediction of early recurrence are lacking.…”

A novel prognostic model for patients with colon adenocarcinoma

“…The nomogram was made simpler with multivariate regression analysis including many prognostic factors into a simplified estimation model constructed to predict the possibility of events (19,20). The nomogram allows clinicians to more visually evaluate the individual health of patients and to offer personalized treatments (21,22). At present, nomograms are commonly applied for prognosis (e.g., OS and DSS of patients with cancer) (23)(24)(25).…”

Nomogram predicting early recurrence defined by the minimum P value approach for colorectal liver metastasis patients receiving colorectal cancer resection with simultaneous liver metastasis resection: development and validation

“…Resections ≥three segments of liver metastases were defined as major resection ( 22 ). Preoperative chemotherapy regimens, with or without bevacizumab and cetuximab, mainly including 5-flfluorouracil or capecitabine, and oxaliplatin or irinotecan, the regimens were recommended to CRLM patients with one or more risk factors of recurrence as previously defined ( 17 , 23 ).…”