Clinical risk scores in the current era of neoadjuvant chemotherapy for colorectal liver metastases.
BACKGROUND
Clinical risk scores (CRS) within the context of neoadjuvant chemotherapy for colorectal liver metastases (CRLM) has not been validated. The predictive value of clinical risk scoring in patients administered neoadjuvant chemotherapy prior to liver surgery for CRLM is evaluated.


METHODS
A prospective database over a 15-year period (April 1999 to March 2014) was analysed. We identified two groups: A, neoadjuvant chemotherapy prior to CRLM surgery; and B, no neoadjuvant chemotherapy.


RESULTS
Overall median survival in groups A and B were 36 (2-137) months and 33 (2-137) months. In group A, nodal status, size, number of metastases and carcinoembryonic antigen levels were not found to be independent predictors of overall survival (OS). However, patients with a shorter disease-free interval of less than 12 months had an increased OS (P = 0.0001). Multivariate analysis of high- and low-risk scores compared against survival in group B (P < 0.05) confirms the applicability of the scoring system in traditional settings.


CONCLUSIONS
Traditional CRS are not a prognostic predictive tool when applied to patients receiving neoadjuvant chemotherapy for CRLM. Disease-free interval may be one independent variable for use in future risk score systems specifically developed for the neoadjuvant chemotherapy era.
Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, UK.
Rohan
R
Kumar
Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, UK.
Ashley R
AR
Dennison
Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, UK.
Vaux
V
Robertson
Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, UK.
Michael J
MJ
Jones
Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, UK.
Christopher P
CP
Neal
Department of Hepato-Pancreato-Biliary Surgery, University Hospitals of Leicester, Leicester, UK.
Giuseppe
G
Garcea
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011237:Predictive Value of Tests; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
clinical risk scores; colorectal liver metastases; liver resection prognosis; neoadjuvant chemotherapy