Development and validation of a novel risk score to predict overall survival following surgical clearance of bilobar colorectal liver metastases
Author:
Dasari Bobby V M12ORCID, Raptis Dimitri3, Syn Nicholas4ORCID, Serrablo Alejandro5, Ramia Jose Manuel6ORCID, Laurenzi Andrea7ORCID, Sturesson Christian8ORCID, Pawlik Timothy M9ORCID, Siriwardena Ajith K10ORCID, Lesurtel Mickael11ORCID, Novotny Alexander, Kow Alfred, Kourdouli Amar, Belli Andrea, Valdivieso Andres, Hann Angus, de la Hoz Rodríguez Ángela, Oona Anisa Nutu, Pascher Andreas, Frena Antonio, Ivanecz Arpad, Heumann Asmus, Alvarado Ayaya Alonso, Kaldarov Ayrat, Bracke Bart, Hendrikx Bart, Struecker Benjamin, Bjornsson Bergthor, Cutolo Carmen, Frola Carlo, Payá-Llorente Carmen, Pozo Carlos Domingo-del, Teh Catherine, Stöss Christian, Ricci Claudio, Verhoef Cornelis, Dopazo Cristina, Galun Daniel, Hartmann Daniel, Martin David, Vaz da Silva Diego Greatti, Dorcaratto Dimitri, Magouliotis Dimitrios, Moris Dimitrios, Symeonidis Dimitrios, Zacharoulis Dimitrios, Bugra Dursun, Lopez-Garnica Dolores, Jonas Eduard, Muttillo Edoardo Maria, Saladino Edoardo, Francisco Elsa, Hutten Ela, De Raffele Emilio, Felli Emanuele, Balik Emre, Bozkurt Emre, Felekouras Evangelos, Sobutay Erman, Sparrelid Ernesto, Romano Fabrizio, Coimbra Felipe José Fernández, Guido Fiorentini, Primavesi Florian, Izzo Francesco, Berrevoet Frederik, Piccolo Gaetano, Joliat Gaëtan-Romain, Middleton Gary, Makridis Georgios, Sotiropoulos Georgios C, Garcea Giuseppe, Booney Glen, Han Ho-Seong, Ozata Ibrahim Halil, Cho Jai Young, Pudil Jiri, Hammond John, Torres Jorge Brian, Li Jun, Pollok Joerg-Matthias, Ammar Khaled, Kopchak Kostiantun, Taura Kojiro, Serin Kursat, Menon Krishna, Zieniewicz Krzysztof, Perez-Santiago Leticia, Lundgren Linda, Wullaert Lissa, Alderghetti Luca, De Carvalho Luis Abreu, Tschöegl Madita-Magdalena, Marino Marco, Aránzazu María, Ammann Markus, Varona-Bosque Aranzazu, Giuffrida Mario, Garancini Mattia, Scotti Mauro Alessandro, Barabino Matteo, Bernon Marc, Cescon Matteo, Martino Marcello Di, Maestri Marcello, Massani Marco, Sotiropoulou Maria, Forcen Maria Teresa Abadia, Fernandez-Moreno Maria-Carmen, Serradilla-Martín Mario, Zivanovic Marko, Gutiérrez-Díez Marta, Buyuk Melek, Vailas Michail, Sharma Mitesh, D'Silva Mizelle, Protic Mladjan, Fard-Aghaie Mohammad Hossein, Wullaert Lissa, Kumar Nagappan, Marques Narimã, Tomara Nefeli, Mowbray Nicholas G, Demartines Nicolas, Machairas Nikolaos, Ben-Ishay Offir, Kvasivka Oleksandr, Krsmanovic Olivera, Bilge Orhan, Sancho-Pardo Pablo, Line Pal-Dag, Tinguely Pascale, Pessaux Patrick, Sandstrom Per, Lodge Peter, Valle Raffaele Dalla, Homs Roger, Sutcliffe Robert, Lob Sanja, Sánchez-Cabús Santiago, Katou Shadi, Okumura Shinya, Hatano Etsuro, Turk Spela, Farkas Stefan, Patauner Stefan, Stättner Stefan, Löb Stefan, Truant Stephanie, Kapiris Stylianos, Gallagher Tom, Kocisova Tereza, Gruenberger Thomas, Stecca Tommaso, Chapelle Thiery, Abadía-Forcén Teresa, Molina Víctor, Sumarokova Valeriia, Meyer Yannick,
Affiliation:
1. Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK 2. Department of HPB Surgery and Liver Transplantation, Queen Elizabeth Hospital , Birmingham , UK 3. Department of HPB Surgery and Liver Transplantation, Royal Free Hospital , London , UK 4. Department of HPB Surgery and Liver Transplantation, National University of Singapore , Singapore 5. HBP Surgical Division, Miguel Servet University Hospital , Zaragoza , Spain 6. Department of Hepatobiliary Surgery and Liver Transplantation, Hospital General Universitario de Alicante , Alicante , Spain 7. Hepatobiliary Surgery and Organ Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna , Bologna , Italy 8. Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital , Stockholm , Sweden 9. Division of Surgery, Oncology, and Health Services Management and Policy, The Ohio State University Wexner Medical Center, Ohio, USA 10. Department of Hepatobiliary Surgery, Manchester Royal Infirmary , Manchester , UK 11. Department of HPB Surgery & Liver Transplantation, Beaujon Hospital—University of Paris Cité , Paris , France
Abstract
Abstract
Background
Bilobar liver metastases from colorectal cancer pose a challenge for obtaining a satisfactory oncological outcome with an adequate future liver remnant. This study aimed to assess the clinical and pathological determinants of overall survival and recurrence-free survival among patients undergoing surgical clearance of bilobar liver metastases from colorectal cancer.
Methods
A retrospective international multicentre study of patients who underwent surgery for bilobar liver metastases from colorectal cancer between January 2012 and December 2018 was conducted. Overall survival and recurrence-free survival at 1, 2, 3 and 5 years after surgery were the primary outcomes evaluated. The secondary outcomes were duration of postoperative hospital stay, and 90-day major morbidity and mortality rates. A prognostic nomogram was developed using covariates selected from a Cox proportional hazards regression model, and internally validated using a 3:1 random partition into derivation and validation cohorts.
Results
A total of 1236 patients were included from 70 centres. The majority (88 per cent) of the patients had synchronous liver metastases. Overall survival at 1, 2, 3 and 5 years was 86.4 per cent, 67.5 per cent, 52.6 per cent and 33.8 per cent, and the recurrence-free survival rates were 48.7 per cent, 26.6 per cent, 19.2 per cent and 10.5 per cent respectively. A total of 25 per cent of patients had recurrent disease within 6 months. Margin positivity and progressive disease at liver resection were poor prognostic factors, while adjuvant chemotherapy in margin-positive resections improved overall survival. The bilobar liver metastases from colorectal cancer-overall survival nomogram was developed from the derivation cohort based on pre- and postoperative factors. The nomogram’s ability to forecast overall survival at 1, 2, 3 and 5 years was subsequently validated on the validation cohort and showed high accuracy (overall C-index = 0.742).
Conclusion
Despite the high recurrence rates, overall survival of patients undergoing surgical resection for bilobar liver metastases from colorectal cancer is encouraging. The novel bilobar liver metastases from colorectal cancer-overall survival nomogram helps in counselling and informed decision-making of patients planned for treatment of bilobar liver metastases from colorectal cancer.
Funder
University Hospitals Birmingham University of Birmingham
Publisher
Oxford University Press (OUP)
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