Validation study of the JSHBPS nomogram for patients with colorectal liver metastases who underwent hepatic resection in the recent era ‐ a nationwide survey in Japan

Abstract

Background The Japanese Society of Hepato‐Biliary‐Pancreatic Surgery (JSHBPS) nomogram was developed to predict disease‐free survival in patients with colorectal liver metastases (CRLM) undergoing upfront hepatectomy. However, the utility of the nomogram in patients with resected CRLM remains unknown in the current situation in which treatment strategies are changing with advances in drugs. Methods Patients in the initial nomogram cohort (n = 727) and validation cohort (n = 2225) were divided into the upfront hepatectomy and preoperative chemotherapy groups. The nomogram was validated by measuring calibration and discrimination in the two cohorts. Calibration curves were plotted, and survival probabilities were compared. Finally, to quantify the discrimination power, we estimated the concordance index (C‐index). Results In the upfront hepatectomy group, the C‐index was 0.63, the suitable cutoff value of the Beppu score was 7, and adjuvant chemotherapy was significantly effective limited to high‐risk patients (Beppu score ≥7). The C‐index was 0.56 in the preoperative chemotherapy group. Conclusions The JSHBPS nomogram remains beneficial for patients undergoing upfront hepatectomy in the recent era but is less effective for patients undergoing hepatectomy after chemotherapy. Patients with a Beppu score ≥7 showed high‐risk recurrence, and adjuvant chemotherapy should be recommended for these patients.

RAS mutation status in combination with the JSHBPS nomogram may be useful for preoperative identification of colorectal liver metastases with high risk of recurrence and mortality after hepatectomy

“…23 The use of preoperative chemotherapy has increased in patients with CRLM. 24 In our study, RAS mutation status was not associated with the use of preoperative chemotherapy, and 29 patients with wild-type RAS received preoperative anti-EGFR antibody. Patients with RAS mutations do not respond to treatment with anti-EGFR antibodies 25 ; however, the use of anti-EGFR antibodies in patients with wild-type RAS may have affected our results.…”

“…The use of preoperative chemotherapy has increased in patients with CRLM 24 . In our study, RAS mutation status was not associated with the use of preoperative chemotherapy, and 29 patients with wild‐type RAS received preoperative anti‐EGFR antibody.…”

Recurrence‐risk stratification using the Beppu score and selection of perioperative chemotherapy for colorectal liver metastases

“…11 We recently performed a validation study in 1756 patients with CRLM who underwent upfront hepatectomy between 2005 and 2007 after introduction of modern chemotherapy in Japan. 16 In the validation cohort, the proportions of patients with a 5-point increase in the Beppu score of the five groups were compared with those in the initial nomogram cohort (Supporting Information: Figure S1). The ratio of patients with Beppu scores ≥11 to all patients decreased, perhaps because of the increased number of patients treated with liver resection following preoperative chemotherapy.…”

“…Furthermore, in 2022, a validation study of the nomogram proved that this score had sufficient discriminatory power in the modern chemotherapy era. 16 Preoperative and postoperative chemotherapy alone or in combination have been attempted for patients with CRLM to decrease recurrences and improve long-term outcomes. [17][18][19][20][21][22][23][24][25][26] Some randomized controlled studies have shown significantly improved DFS or progression-free survival, but not overall survival (OS).…”

“…26 It is well-known that perioperative chemotherapy is efficacious for selected patients but not for all patients; therefore, preoperative recurrence-risk stratification for CRLM is required to select suitable candidates. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] The aim of this review article was to summarize the postoperative recurrence-risk and therapeutic effects of perioperative chemotherapy based on the Beppu score for risk stratification.…”