title: Implications of clinical risk score to predict outcomes of liver-confined metastasis of colorectal cancer.
abstract: OBJECTIVE
  We investigated the usefulness of a clinical risk scoring system (CRS) for guiding management and defining prognosis for patients with colorectal liver met"astases (CLM).
  
  
  METHODS
  We retrospectively analyzed data about the correlation between outcomes and Fong's CRS from 1989 to 2010 for patients treated for CLM at the Severance Hospital.
  
  
  RESULTS
  Of 566 patients, 232 received adjuvant treatment after liver resection. Of these patients, 185 (81%) had a low CRS (0-2) and 47 (19%) had a high CRS (3-5). Stratification into high and low CRS allowed significant distinction between Kaplan-Meier curves for outcome. The 5-year survival rate was 88.5% and 11.5% among patients with a low and high CRS, respectively (P < 0.001). Seventy patients with initially unresectable CLM underwent liver resection after tumor downsizing by induction chemotherapy. Shifting of the CRS from high to low (8 patients; 11.4%) improved disease-free survival and overall survival.
  
  
  CONCLUSIONS
  High CRS is associated with worse survival after resection in resectable and unresectable disease. The CRS may be used for risk assessment when recommending oncological surgical timing in initially unresectable disease and treatment options for perioperative or adjuvant treatment in resectable disease.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Shin
authors.forename: Joong Bae
authors.initials: JB
authors.lastname: Ahn
authors.forename: Jin Sub
authors.initials: JS
authors.lastname: Choi
authors.forename: Gi-Hong
authors.initials: GH
authors.lastname: Choi
authors.forename: Kang Young
authors.initials: KY
authors.lastname: Lee
authors.forename: Seung Hyuk
authors.initials: SH
authors.lastname: Baik
authors.forename: Byung Soh
authors.initials: BS
authors.lastname: Min
authors.forename: Hyuk
authors.initials: H
authors.lastname: Hur
authors.forename: Jae Kyung
authors.initials: JK
authors.lastname: Roh
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017115:Catheter Ablation / Q000379:methods / Q000401:mortality; D015179:Colorectal Neoplasms; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000401:mortality; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult