title: Nomogram for prediction of prognosis in patients with initially unresectable colorectal liver metastases.
abstract: BACKGROUND
  Although recent advances in surgery and chemotherapy have increasingly enabled hepatectomy in patients with initially unresectable colorectal liver metastases (CRLM), not all such patients benefit from surgery. The aim of this study was to develop a nomogram to predict survival after hepatectomy for initially unresectable CRLM.
  
  
  METHODS
  Patients with initially unresectable CRLM treated with chemotherapy followed by hepatectomy between 1990 and 2012 were included in the study. A nomogram to predict survival was developed based on a multivariable Cox model. The predictive performance of the model was assessed according to the C-statistic, Kaplan-Meier curve and calibration plots.
  
  
  RESULTS
  Of a total of 439 patients, liver and globally completed surgery was achieved in 380 (86·6 per cent) and 335 (76·3 per cent) patients respectively. The 5-year overall and disease-free survival rates were 39·9 and 10·0 per cent respectively. Based on the Cox model, the following five factors were selected for the nomogram and assigned specific scores: node-positive primary, 5; more than six metastases at hepatectomy, 7; carbohydrate antigen 19-9 level at hepatectomy above 37 units/ml, 10; disease progression during first-line chemotherapy, 9; and presence of extrahepatic disease, 4. The model achieved relatively good discrimination and calibration, with a C-statistic of 0·66. The overall survival rate for patients with a score greater than 16 was significantly worse than that for patients with a score of 16 or less (5-year survival rate 4 versus 46·3 per cent respectively; P < 0·001).
  
  
  CONCLUSIONS
  The nomogram facilitates personalized assessment of prognosis for patients with initially unresectable CRLM treated with chemotherapy and with planned resection.
authors.affiliation: Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France.|Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 935, Villejuif, France.|Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Imai
authors.affiliation: Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France.|Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 935, Villejuif, France.|Université Paris-Sud, Villejuif, France.
authors.forename: M-A
authors.initials: MA
authors.lastname: Allard
authors.affiliation: Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France.|Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 935, Villejuif, France.|Université Paris-Sud, Villejuif, France.
authors.forename: C
authors.initials: C
authors.lastname: Castro Benitez
authors.affiliation: Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France.|INSERM, Unité 785, Villejuif, France.|Université Paris-Sud, Villejuif, France.
authors.forename: E
authors.initials: E
authors.lastname: Vibert
authors.affiliation: Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France.|Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 935, Villejuif, France.|Université Paris-Sud, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Sa Cunha
authors.affiliation: Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France.|INSERM, Unité 785, Villejuif, France.|Université Paris-Sud, Villejuif, France.
authors.forename: D
authors.initials: D
authors.lastname: Cherqui
authors.affiliation: Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France.|INSERM, Unité 785, Villejuif, France.|Université Paris-Sud, Villejuif, France.
authors.forename: D
authors.initials: D
authors.lastname: Castaing
authors.affiliation: Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France.
authors.forename: H
authors.initials: H
authors.lastname: Bismuth
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Baba
authors.affiliation: Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, Villejuif, France.|Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 935, Villejuif, France.|Université Paris-Sud, Villejuif, France.
authors.forename: R
authors.initials: R
authors.lastname: Adam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D000066491:Clinical Decision-Making / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D049451:Nomograms; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents