title: CALy Prognostic Score (CEA, ALP, Lymphocyte Count) as a predictor of survival after hepatectomy for liver-only colorectal metastases.
abstract: OBJECTIVE
  The discovery of prognostic factors for patients who undergo hepatectomy for colorectal liver metastases (CRLM) in the era of neoadjuvant chemotherapy is imperative. This study aimed to establish a simple, cheap and easily available prognostic score for these patients.
  
  
  METHODS
  Preoperative carcinoembryonic antigen (CEA), serum alkaline phosphatase (ALP), and lymphocyte count (LC) were used for the establishment of a prognostic score (CALy PS). The cut-off levels of these variables were determined by applying receiver operating curve (ROC) analysis. The final prognostic score assigned one risk point for each variable (CEA>4 μg/L, ALP>93 U/L, and LC≥1.6x10(9)/L).
  
  
  RESULTS
  One hundred and thirty-five patients were included. Two risk categories were established with 0-1 and 2-3 points, respectively. CALy 0-1 vs CALy 2-3, and CALy 2-3 were associated with decreased disease free survival (DFS) and overall survival (OS) both in univariate and multivariate analysis (DFS: HR 1.84; 95% CI 1.18-2.86; p=0.007; OS: HR 2.25; 95% CI 1.23-4.11; p=0.008). When four risk categories were established with 0,1,2,and 3 points,CALy was again associated with decreased DFS and OS both in univariate and in multivariate analysis (DFS: HR 1.37; 95% CI 1.083-1.74; p=0.009; OS:HR 1.84; 95% CI 1.31-2.59; p<0.001). Three-year DFS rates for these categories (CALy 0, CALy 1, CALy 2, and CALy 3) were 45, 38, 15 and 7%, respectively, and the 5-year OS rates were 78, 68, 32, and 24%, respectively.
  
  
  CONCLUSIONS
  This simple, cheap, and easily available risk score provides good prognostic accuracy for both DFS and OS for patients undergoing liver resection for liver-only colorectal metastases after neoadjuvant chemotherapy.
authors.affiliation: Department of Academic Surgery, Royal Marsden Hospital, Fulham Road, London, UK.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Neofytou
authors.forename: Alexandros
authors.initials: A
authors.lastname: Giakoustidis
authors.forename: Satvinder
authors.initials: S
authors.lastname: Mudan
mesh_terms: D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood*; D019540:Area Under Curve; D002272:Carcinoembryonic Antigen / Q000097:blood*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000276:immunology / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002272:Carcinoembryonic Antigen; D000469:Alkaline Phosphatase