Cancer Res Treat.  2015 Apr;47(2):242-250. 10.4143/crt.2014.066.

Novel Methods for Clinical Risk Stratification in Patients with Colorectal Liver Metastases

Affiliations
  • 1Oral Cancer Research Institute, Seoul, Korea.
  • 2Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
  • 3Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, Korea.
  • 4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. ssj338@yuhs.ac
  • 5Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Colorectal cancer patients with liver-confined metastases are classified as stage IV, but their prognoses can differ from metastases at other sites. In this study, we suggest a novel method for risk stratification using clinically effective factors.
MATERIALS AND METHODS
Data on 566 consecutive patients with colorectal liver metastasis (CLM) between 1989 and 2010 were analyzed. This analysis was based on principal component analysis (PCA).
RESULTS
The survival rate was affected by carcinoembryonic antigen (CEA) level (p < 0.001; risk ratio, 1.90), distribution of liver metastasis (p=0.014; risk ratio, 1.46), and disease-free interval (DFI; p < 0.001; risk ratio, 1.98). When patients were divided into three groups according to PCA score using significantly affected factors, they showed significantly different survival patterns (p < 0.001).
CONCLUSION
The PCA scoring system based on CEA level, distribution of liver metastasis, and DFI may be useful for preoperatively determining prognoses in order to assist in clinical decisionmaking and designing future clinical trials for CLM treatment.

Keyword

Risk calculation; Patient stratification; Colorectal neoplasms; Liver metastasis

MeSH Terms

Carcinoembryonic Antigen
Colorectal Neoplasms
Humans
Liver*
Neoplasm Metastasis*
Odds Ratio
Passive Cutaneous Anaphylaxis
Principal Component Analysis
Prognosis
Survival Rate
Carcinoembryonic Antigen

Figure

  • Fig. 1. Comparison of accuracy, specificity, and sensitivity in training and test data sets. Results are from 500 rounds of simulation. The sizes of training and test data sets were 396 (70%) and 170 (30%), respectively. The symbol×indicates accuracy, specificity, and sensitivity of Fong’s criteria.

  • Fig. 2. Kaplan-Meier survival curves of risk groups defined by principal component analysis scores. Comparison of three risk groups (A); group 1 vs. group 2 (B); and group 2 vs. group 3 (C).

  • Fig. 3. Kaplan-Meier survival curves of risk groups defined by Fong’s score. (A) Comparison of survival patterns between two vs. six groups. (B) Pairwise comparisons.


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Juan Garona, Natasha T. Sobol, Marina Pifano, Valeria I. Segatori, Daniel E. Gomez, Giselle V. Ripoll, Daniel F. Alonso
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Reference

References

1. Adam R, Hoti E, Folprecht G, Benson AB. Accomplishments in 2008 in the management of curable metastatic colorectal cancer. Gastrointest Cancer Res. 2009; 3(5 Suppl 2):S15–22.
2. Stangl R, Altendorf-Hofmann A, Charnley RM, Scheele J. Factors influencing the natural history of colorectal liver metastases. Lancet. 1994; 343:1405–10.
Article
3. Mella J, Biffin A, Radcliffe AG, Stamatakis JD, Steele RJ. Population-based audit of colorectal cancer management in two UK health regions. Colorectal Cancer Working Group, Royal College of Surgeons of England Clinical Epidemiology and Audit Unit. Br J Surg. 1997; 84:1731–6.
4. Poston GJ, Adam R, Alberts S, Curley S, Figueras J, Haller D, et al. OncoSurge: a strategy for improving resectability with curative intent in metastatic colorectal cancer. J Clin Oncol. 2005; 23:7125–34.
Article
5. Rees M, John TG. Current status of surgery in colorectal metastases to the liver. Hepatogastroenterology. 2001; 48:341–4.
6. Papadimitriou JD, Fotopoulos AC, Prahalias AA, Vassiliou JG, Papadimitriou LJ. The impact of new technology on hepatic resection for malignancy. Arch Surg. 2001; 136:1307–13.
Article
7. Adam R, Avisar E, Ariche A, Giachetti S, Azoulay D, Castaing D, et al. Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal. Ann Surg Oncol. 2001; 8:347–53.
8. Tournigand C, Andre T, Achille E, Lledo G, Flesh M, Mery-Mignard D, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol. 2004; 22:229–37.
Article
9. Pozzo C, Basso M, Cassano A, Quirino M, Schinzari G, Trigila N, et al. Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients. Ann Oncol. 2004; 15:933–9.
Article
10. Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Resection of colorectal liver metastases. World J Surg. 1995; 19:59–71.
Article
11. Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer. 1996; 77:1254–62.
12. Taylor M, Forster J, Langer B, Taylor BR, Greig PD, Mahut C. A study of prognostic factors for hepatic resection for colorectal metastases. Am J Surg. 1997; 173:467–71.
Article
13. Iwatsuki S, Dvorchik I, Madariaga JR, Marsh JW, Dodson F, Bonham AC, et al. Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system. J Am Coll Surg. 1999; 189:291–9.
14. Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick RD, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg. 2002; 235:759–66.
Article
15. Ambiru S, Miyazaki M, Isono T, Ito H, Nakagawa K, Shimizu H, et al. Hepatic resection for colorectal metastases: analysis of prognostic factors. Dis Colon Rectum. 1999; 42:632–9.
16. Gomez D, Cameron IC. Prognostic scores for colorectal liver metastasis: clinically important or an academic exercise? HPB (Oxford). 2010; 12:227–38.
Article
17. Welsh FK, Tekkis PP, John TG, Rees M. Predictive models in colorectal liver metastases--can we personalize treatment and outcome? Dig Surg. 2008; 25:406–12.
18. Merkel S, Bialecki D, Meyer T, Muller V, Papadopoulos T, Hohenberger W. Comparison of clinical risk scores predicting prognosis after resection of colorectal liver metastases. J Surg Oncol. 2009; 100:349–57.
Article
19. Reissfelder C, Rahbari NN, Koch M, Ulrich A, Pfeilschifter I, Waltert A, et al. Validation of prognostic scoring systems for patients undergoing resection of colorectal cancer liver metastases. Ann Surg Oncol. 2009; 16:3279–88.
Article
20. Fong Y, Salo J. Surgical therapy of hepatic colorectal metastasis. Semin Oncol. 1999; 26:514–23.
Article
21. Mann CD, Metcalfe MS, Leopardi LN, Maddern GJ. The clinical risk score: emerging as a reliable preoperative prognostic index in hepatectomy for colorectal metastases. Arch Surg. 2004; 139:1168–72.
22. Arru M, Aldrighetti L, Castoldi R, Di Palo S, Orsenigo E, Stella M, et al. Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer. World J Surg. 2008; 32:93–103.
Article
23. Nanashima A, Sumida Y, Abo T, Tobinaga S, Takeshita H, Hidaka S, et al. A modified grading system for post-hepatectomy metastatic liver cancer originating from colorectal carcinoma. J Surg Oncol. 2008; 98:363–70.
Article
24. Schindl M, Wigmore SJ, Currie EJ, Laengle F, Garden OJ. Prognostic scoring in colorectal cancer liver metastases: development and validation. Arch Surg. 2005; 140:183–9.
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