Value of prognostic scoring systems in the era of multimodal therapy for recurrent colorectal liver metastases

Katharina Joechle; Iakovos Amygdalos; Felix Schmidt; Jan Bednarsch; Alexandros Chrysos; Franziska A Meister; Zoltan Czigany; Daniel Heise; Marie-Luise Berres; Philipp Bruners; Tom F Ulmer; Ulf P Neumann; Sven A Lang

doi:10.1016/j.hpb.2023.06.016

Value of prognostic scoring systems in the era of multimodal therapy for recurrent colorectal liver metastases

HPB (Oxford). 2023 Nov;25(11):1354-1363. doi: 10.1016/j.hpb.2023.06.016. Epub 2023 Jun 28.

Affiliations

¹ Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, 52074, Aachen, Germany; Center for Integrated Oncology Aachen, Boon, Cologne and Duesseldorf (CIO ABCD), Site, Aachen, Germany.
² Department of Internal Medicine III, University Hospital RWTH Aachen, 52074, Aachen, Germany; Center for Integrated Oncology Aachen, Boon, Cologne and Duesseldorf (CIO ABCD), Site, Aachen, Germany.
³ Department of Diagnostic und Interventional Radiology, University Hospital RWTH Aachen, 52074, Aachen, Germany; Center for Integrated Oncology Aachen, Boon, Cologne and Duesseldorf (CIO ABCD), Site, Aachen, Germany.
⁴ Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, 52074, Aachen, Germany; Center for Integrated Oncology Aachen, Boon, Cologne and Duesseldorf (CIO ABCD), Site, Aachen, Germany. Electronic address: svlang@ukaachen.de.

PMID: 37438185
DOI: 10.1016/j.hpb.2023.06.016

Abstract

Background: Various predictive scoring systems have been developed to estimate outcomes of patients undergoing surgery for colorectal liver metastases (CRLM). However, data regarding their effectiveness in recurrent CRLM (recCRLM) are very limited.

Methods: Patients who underwent repeat hepatectomy for recCRLM at the University Hospital RWTH Aachen, Germany from 2010 to 2021 were included. Nine predictive scoring systems (Fong's, Nordlinger, Nagashima, RAS mutation, Tumor Burden, GAME, CERR, and Glasgow Prognostic score, Basingstoke Index) were evaluated by likelihood ratio (LR) χ², linear trend (LT) χ² and Akaike Information Criterion (AIC) for their predictive value regarding overall survival (OS) and recurrence free survival (RFS).

Results: Among 150 patients, median RFS was 9 (2-124) months with a 5-year RFS rate of 10%. Median OS was 39 (4-131) months with a 5-year OS rate of 32%. For RFS and OS, the Nagashima score showed the best prognostic ability (LT χ² 3.00, LR χ² 9.39, AIC 266.66 and LT χ² 2.91, LR χ² 20.91, 290.36).

Discussion: The Nagashima score showed the best prognostic stratification to predict recurrence as well as survival, and therefore might be considered when evaluating patients with recCRLM for repeat hepatectomy.