title: Indication for neoadjuvant chemotherapy in patients with colorectal liver metastases based on a nomogram that predicts disease-free survival.
abstract: BACKGROUND
  The purpose of this study was to validate the Beppu nomogram, which predicts disease-free survival (DFS) after resection of colorectal liver metastases, and to investigate the efficacy of neoadjuvant chemotherapy based on the nomogram-predicted recurrence risk.
  
  
  METHODS
  We retrospectively analyzed 234 patients with colorectal liver metastases who underwent a hepatic resection at eight hospitals between 2005 and 2010.
  
  
  RESULTS
  The nomogram c-index of all the patients was 0.59. The observed and the predicted 3-year DFS showed good agreement. When the patients were divided into two groups who received or did not receive pre-hepatectomy chemotherapy (PHC), the c-index of the patients who received PHC was inferior to that of the patients who did not (0.56 and 0.61, respectively). In patients who received PHC, DFS among the quintiles clustered by the nomogram score indicated no significant differences (P = 0.25), unlike in patients who did not receive PHC (P < 0.0001). Surprisingly, in patients with no risk factors for recurrence, neoadjuvant chemotherapy provided significantly lower DFS than no neoadjuvant chemotherapy (3-year DFS: 42.9% vs. 80.0%, P = 0.03).
  
  
  CONCLUSIONS
  The nomogram validation was shown to be moderately predictive. PHC decreased the performance of the nomogram and might produce no DFS benefit in patients with low recurrent risk.
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Syogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Okuno
authors.forename: Etsuro
authors.initials: E
authors.lastname: Hatano
authors.forename: Satoru
authors.initials: S
authors.lastname: Seo
authors.forename: Kojiro
authors.initials: K
authors.lastname: Taura
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yasuchika
authors.forename: Akio
authors.initials: A
authors.lastname: Nakajima
authors.forename: Takefumi
authors.initials: T
authors.lastname: Yazawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Furuyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawamoto
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yagi
authors.forename: Ryuta
authors.initials: R
authors.lastname: Nishitai
authors.forename: Takahisa
authors.initials: T
authors.lastname: Fujikawa
authors.forename: Akira
authors.initials: A
authors.lastname: Arimoto
authors.forename: Masazumi
authors.initials: M
authors.lastname: Zaima
authors.forename: Tsunehiro
authors.initials: T
authors.lastname: Yoshimura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Terajima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kaihara
authors.forename: Dai
authors.initials: D
authors.lastname: Manaka
authors.forename: Akira
authors.initials: A
authors.lastname: Tanaka
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D008297:Male; D020360:Neoadjuvant Therapy; D049451:Nomograms; D011237:Predictive Value of Tests; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor
keywords: Colorectal liver metastases; Hepatic resection; Neoadjuvant chemotherapy; Nomogram