title: Survival of patients operated for colorectal liver metastases and concomitant extra-hepatic disease: external validation of a prognostic model.
abstract: BACKGROUND
  The presence of extra-hepatic disease (EHD) is no longer an absolute contraindication to surgery in patients with colorectal liver metastases (CRLM). Recently, a novel prognostic model predicting overall survival in such patients was proposed using five risk factors (EHD other than isolated lung metastases, CEA ≥10 ng/ml, >5 liver metastases, right colon as the primary CRC location, and diagnosis of EHD concomitant to CRLM recurrence). A bi-institutional database was used to perform an external validation of this model.
  
  
  METHODS
  Ninety-seven patients operated for CRLM and EHD between 1982 and 2011 in two institutions was analyzed. The proposed prognostic model was validated in this cohort using Cox proportional hazards models and the concordance index (c).
  
  
  RESULTS
  Of the five proposed risk factors, only EHD other than isolated lung metastases was found to independently predict overall survival [Hazards Ratio (HR) = 2.10 (95% CI: 1.01-4.40)]. Although, the number of risk factors was marginally associated with overall survival in univariate analysis (P = 0.049), the performance of the proposed prognostic model was poor when applied to our cohort (c = 0.64).
  
  
  CONCLUSIONS
  The examined prognostic model of survival in patients with CRLM and EHD had poor performance. Further research is warranted to delineate the subset of patients who will benefit from surgery.
authors.affiliation: Departments of Surgery at Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Mavros
authors.forename: Omar
authors.initials: O
authors.lastname: Hyder
authors.forename: Carlo
authors.initials: C
authors.lastname: Pulitano
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000008:Abdominal Neoplasms / Q000556:secondary; D002272:Carcinoembryonic Antigen / Q000097:blood; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D008175:Lung Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D010386:Pelvic Neoplasms / Q000556:secondary; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D002272:Carcinoembryonic Antigen