Histopathological Helsinki score of colorectal liver metastases predicts survival after liver resection

Abstract

Several perioperative scoring systems have been created to predict outcomes in metastatic colorectal cancer; however, these rarely include histological parameters. We evaluated histological factors used for patients with liver metastases operated between 2000 and 2019 and compared the results with the Fong score. Many scoring models for overall disease‐free survival (DFS) were established and compared using multivariate Cox proportional hazard models. Statistically significant predictors at a 5% level in the univariate analysis were included in the multivariate models using the backward and forward selection methods. Per these models, we established a score of eight histological factors. We defined low‐, intermediate‐, and high‐risk groups and compared them using the Kaplan–Meier survival and receiver operating characteristics (ROC) analyses. The histological score's accuracy was compared with the modified Fong clinical risk score. The following factors constituted the Helsinki score: advanced pT stage, node‐positive primary, ≥2 metastases, size >50 mm, vitality >30%, margin <5 mm, vascular invasion and biliary invasion. The high‐risk group had significantly worse DFS and overall survival. In ROC analyses, the Helsinki score was slightly better than the modified Fong clinical risk score. Helsinki score challenges physicians to acknowledge histological factors as important outcome measures.