Prognostic factors and evaluation of a clinical score for predicting survival after resection of colorectal liver metastases.
BACKGROUND
Patient outcome after resection of colorectal liver metastases can be predicted by various prognostic factors.


OBJECTIVE
Development of a model for risk stratification based on analysis of prognostic factors.


METHODS
Data of 201 patients were collected prospectively and included in a single-centre trial. A total of 20 factors were analysed as to their influence on recurrence-free and overall survival. Independent prognostic factors were entered into a model of a clinical risk score.


RESULTS
Median recurrence-free survival reached 24 months for all patients; median overall survival was 50 months. Only a synchronous manifestation of primary colorectal carcinoma and liver metastases, the presence of four or more metastases and a carcino-embryonic antigen level of 200 ng/ml or more significantly influenced recurrence-free and overall survival in the multivariate analysis. The derived risk stratification grouped the patients according to the following criteria: low risk, zero prognostic factors (n=112); intermediate risk, one factor (n=74); high risk, two or more factors (n=15). The median recurrence-free survival for low, intermediate and high risk were 30.0, 23.0 and 11.0 months, respectively; the median overall survival was 94.0, 40.0 and 33.0 months. Compared with the low-risk group, patients with intermediate risk demonstrated an increased hazard ratio (HR) of 1.57-fold for recurrence (P=0.018) and 1.91-fold for mortality (P=0.007). For the high-risk group, the HR rose significantly to 3.26 for recurrence (P<0.0005) and to 3.10 for mortality (P=0.001).


CONCLUSIONS
The presented clinical score may allow for patients with colorectal liver metastases to be stratified appropriately and for optimization of their subsequent therapeutic management.
Konopke
Ralf
R
Department of General, Thoracic and Vascular Surgery, University of Technology, Dresden, Germany. ralf.konopke@uniklinikum-dresden.de
Kersting
Stephan
S
Distler
Marius
M
Dietrich
Jeannine
J
Gastmeier
Jörg
J
Heller
Axel
A
Kulisch
Eberhard
E
Saeger
Hans-Detlev
HD
D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000601:surgery*; D011379:Prognosis; D012107:Research Design; D018570:Risk Assessment / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome