Nontumor related risk score: A new tool to improve prediction of prognosis after hepatectomy for colorectal liver metastases.

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.

• Authors: Kazunari Sasaki, Georgios Antonios Margonis, Amika Moro, Jane Wang, Doris Wagner, Johan Gagnière, Jung Kyong Shin, Mizelle D'Silva, Kota Sahara, Tatsunori Miyata, Jiro Kusakabe, Katharina Beyer, Aurélien Dupré, Carsten Kamphues, Katsunori Imai, Hideo Baba, Itaru Endo, Kojiro Taura, Jai Young Cho, Federico Aucejo, Peter Kornprat, Martin E Kreis, Jong Man Kim, Richard Burkhart, Choon Hyuck David Kwon, Timothy M Pawlik
• Journal: Surgery (Surgery) Vol. 171 Issue 6 Pg. 1580-1587 (06 2022) ISSN: 1532-7361 [Electronic] United States
• PMID: 35221105 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Elsevier Inc. All rights reserved.

Chemical References

• Albumins
• Alkaline Phosphatase

Topics

• Albumins
• Alkaline Phosphatase
• Colorectal Neoplasms (pathology)
• Hepatectomy
• Humans
• Liver Neoplasms (secondary)
• Prognosis
• Retrospective Studies
• Risk Factors