Nontumor related risk score: A new tool to improve prediction of prognosis after hepatectomy for colorectal liver metastases
- Authors
- Sasaki, K.[Sasaki, K.]; Margonis, G.A.[Margonis, G.A.]; Moro, A.[Moro, A.]; Wang, J.[Wang, J.]; Wagner, D.[Wagner, D.]; Gagnière, J.[Gagnière, J.]; Shin, J.K.[Shin, J.K.]; D'Silva, M.[D'Silva, M.]; Sahara, K.[Sahara, K.]; Miyata, T.[Miyata, T.]; Kusakabe, J.[Kusakabe, J.]; Beyer, K.[Beyer, K.]; Dupré, A.[Dupré, A.]; Kamphues, C.[Kamphues, C.]; Imai, K.[Imai, K.]; Baba, H.[Baba, H.]; Endo, I.[Endo, I.]; Taura, K.[Taura, K.]; Cho, J.Y.[Cho, J.Y.]; Aucejo, F.[Aucejo, F.]; Kornprat, P.[Kornprat, P.]; Kreis, M.E.[Kreis, M.E.]; Kim, J.M.[Kim, J.M.]; Burkhart, R.[Burkhart, R.]; David, Kwon C.H.[David, Kwon C.H.]; Pawlik, T.M.[Pawlik, T.M.]
- Issue Date
- May-2022
- Publisher
- Elsevier Inc.
- Citation
- Surgery (United States), v.171, no.5, pp.1580 - 1587
- Indexed
- SCIE
SCOPUS
- Journal Title
- Surgery (United States)
- Volume
- 171
- Number
- 5
- Start Page
- 1580
- End Page
- 1587
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/97419
- DOI
- 10.1016/j.surg.2022.01.030
- ISSN
- 0039-6060
- Abstract
- Background: Prognostic stratification of patients with colorectal cancer liver metastasis based solely on tumor-related factors has only moderate discriminatory ability. We hypothesized that the inclusion of nontumor related factors can improve prediction of long-term prognosis of patients with colorectal cancer liver metastasis. Methods: Nontumor related laboratory markers were assessed utilizing a training cohort from 2 U.S. institutions (n = 1,205). Factors independently associated with prognosis were used to develop a nontumor related prognostic score. The discriminatory ability, assessed by Harrell's C-statistics (C-index) and net reclassification improvement, was validated and compared with 3 commonly used tumor-related clinical risk scores: Fong clinical risk scores, m-clinical risk scores, and Genetic and Morphological Evaluation (GAME) score in an external validation cohort from 5 Asian (n = 1,307) and 3 European (n = 1,058) institutions. The discriminatory ability of nontumor related prognostic score combined with each of these 3 tumor-related prognostic scores was also estimated. Results: Alkaline phosphatase (hazard ratio 1.43; 95% confidence interval, 1.11–1.84), albumin (hazard ratio 0.71; 95% confidence interval, 0.57–0.89), and mean corpuscular volume (hazard ratio 19.0, per log unit; 95% confidence interval, 4.79–75.0) were each independently associated with increased risk of death after resection of colorectal cancer liver metastasis (all P <.05). In turn, alkaline phosphatase, albumin, and mean corpuscular volume were combined to form a nontumor related prognostic score (2.942 × mean corpuscular volume + 0.399 × alkaline phosphatase-0.339 × albumin-12) × 10 (median, 16; range, 1–30). The nontumor related prognostic score had good-to-modest discriminatory ability in the external cohort (C-index = 0.58), which was comparable to the 3 established tumor-related prognostic scores (C-index: Fong clinical risk scores, 0.53, m-clinical risk scores, 0.55, GAME, 0.58). The addition of the nontumor related prognostic score to the tumor-related prognostic scores enhanced the discriminatory ability in the entire study cohort (C-index: nontumor related score+Fong, 0.60, nontumor related score+m-clinical risk scores, 0.61, nontumor related score+GAME, 0.64), as well reclassification improvement (42.5, 42.7%, and 21.2%, respectively). Conclusion: Nontumor related prognostic information may help improve the prognostic stratification of patients after resection of colorectal cancer liver metastasis. The nontumor related prognostic score may be combined with tumor-related prognostic tools to enhance prognostic stratification of patients with colorectal cancer liver metastasis. © 2022 Elsevier Inc.
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