Welsh Fenella K S, Tekkis Paris P, John Timothy G, Rees Myrddin
Department of Hepatobiliary Surgery, North Hampshire Hospital, Basingstoke, UK.
Dig Surg. 2008;25(6):406-12. doi: 10.1159/000184731. Epub 2009 Feb 12.
BACKGROUND/AIMS: Hepatic resection for colorectal liver metastases offers patients the best chance of long-term survival. Survival rates after resection range from 25 to 60%. Predictive models may risk-stratify patients and allow improved selection for surgery or other therapies. This review aims to achieve consensus regarding the predictors of survival after hepatic resection for colorectal metastases and evaluate current predictive models of outcome.
A comprehensive literature review of published studies with more than 500 patients describing models for predicting long-term survival in patients undergoing hepatic resection for colorectal metastases.
Five large predictive models have been published to date. The three predictive models developed from the largest series agree over the key independent predictors of poor long-term outcome for patients undergoing liver resection for colorectal metastases. All five models have individual shortcomings, and whilst three have been internally validated, two have been externally validated with conflicting results. The Basingstoke Predictive Index appears to be accurate and internally validated.
There is need within the international surgical oncology community for consensus regarding a predictive model to be universally adopted for risk-stratifying patients who may benefit from intensive surveillance and selection for adjuvant therapy and clinical trials.
背景/目的：肝切除治疗结直肠癌肝转移为患者提供了最佳的长期生存机会。切除术后的生存率在25%至60%之间。预测模型可以对患者进行风险分层，从而更好地选择手术或其他治疗方法。本综述旨在就结直肠癌肝转移肝切除术后生存的预测因素达成共识，并评估当前的预后预测模型。
对已发表的研究进行全面的文献综述，这些研究纳入了500多名患者，描述了预测结直肠癌肝转移肝切除患者长期生存的模型。
迄今为止已发表了五个大型预测模型。从最大样本量系列研究中得出的三个预测模型，在结直肠癌肝转移肝切除患者长期预后不良的关键独立预测因素上达成了一致。所有五个模型都有各自的缺点，其中三个模型进行了内部验证，两个模型进行了外部验证，但结果相互矛盾。贝辛斯托克预测指数似乎较为准确且经过了内部验证。
国际外科肿瘤学界需要就一个预测模型达成共识，以便对可能从强化监测以及辅助治疗和临床试验选择中获益的患者进行普遍适用的风险分层。
