Preoperative prognostic score for predicting survival after hepatic resection for colorectal liver metastases.
BACKGROUND
Despite indications for resection of colorectal liver metastases having expanded, debate continues about identifying patients that may benefit from surgery.


METHODS
Clinicopathologic data from a total of 700 patients was gathered between January 1993 and January 2006 from a prospectively maintained dataset. Of these, 687 patients underwent resection for colorectal liver metastases.


RESULTS
The median age of patient was 64 years and 36.8% of patients had synchronous disease. The overall 5-year survival was 45%. The presence of an inflammatory response to tumor (IRT), defined by an elevated C-reactive protein (>10 mg/L) or a neutrophil/lymphocyte ratio of >5:1, was noted in 24.5% of cases. Only the number of metastases and the presence or absence of an IRT influenced both overall and disease-free survival on multivariable analysis. A preoperative prognostic score was derived: 0 = less than 8 metastases and absence of IRT; 1 = 8 or more metastases or IRT, and 2 = 8 or more metastases and IRT-from the results of the multivariable analysis. The 5-year survival of those scoring 0 was 49% compared with 34% for those scoring 1. None of the patients that scored 2 were alive at 5 years.


CONCLUSIONS
The preoperative prognostic score is a simple and effective system allowing preoperative stratification.
Malik
Hassan Z
HZ
HPB and Transplant Unit, St. James's University Hospital, Leeds, UK.
Prasad
K Rajendra
KR
Halazun
Karim J
KJ
Aldoori
Amir
A
Al-Mukhtar
Ahmed
A
Gomez
Dhanwant
D
Lodge
J Peter A
JP
Toogood
Giles J
GJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
D002097:C-Reactive Protein