Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Ann Surg Oncol. 2009 Dec;16(12):3279-88. doi: 10.1245/s10434-009-0654-7.
Several prognostic scoring systems have been established for patients undergoing resection of colorectal cancer (CRC) liver metastases; however, comparative analyses of their prognostic relevance is still lacking in the literature. The aim of the present study was to assess the predictive value of five published scoring systems in an independent patient cohort for the purpose of external validation.
A total of 281 patients underwent liver resection for CRC liver metastases at our institution between January 2002 and January 2008. The predictive value of the Nordlinger score, Memorial Sloan-Kettering Cancer Center (MSKCC) score, Iwatsuki score, Basingstoke index, and Mayo scoring system was assessed in this patient set. Furthermore, clinical and pathologic parameters included in the assessed scoring systems were analyzed by means of univariate and multivariate analyses.
The disease-specific survival at 1, 3, and 5 years was 94.6%, 61.8%, and 33.7%, respectively. Of the assessed scoring systems, only the MSKCC score (P = .006) and the Iwatsuki score (P = .01) provided a statistically significant stratification of patients with regard to survival. The predictive value was particularly evident for patients grouped within the high-risk categories. None of these patients was alive at 3 years after surgery. The 3-year survival rates for high-risk patients in the remaining three scoring systems was > 50%.
In our patient cohort, survival was only predicted by MSKCC and Iwatsuki scores. These findings highlight the importance of validating scoring systems in independent patient groups.
已经建立了几种用于结直肠癌（CRC）肝转移切除术患者的预后评分系统；然而，文献中仍然缺乏对其预后相关性的比较分析。本研究的目的是在独立的患者队列中评估五项已发表评分系统的预测价值，以便进行外部验证。
2002 年 1 月至 2008 年 1 月期间，共有 281 例患者在我院接受了结直肠癌肝转移的肝切除术。在该患者组中评估了 Nordlinger 评分、纪念斯隆-凯特琳癌症中心（MSKCC）评分、Iwatsuki 评分、Basingstoke 指数和 Mayo 评分系统的预测价值。此外，还通过单因素和多因素分析评估了纳入评估评分系统的临床和病理参数。
1、3、5 年疾病特异性生存率分别为 94.6%、61.8%和 33.7%。在所评估的评分系统中，只有 MSKCC 评分（P=0.006）和 Iwatsuki 评分（P=0.01）能够对患者的生存情况进行统计学上的分层。对于处于高危类别的患者，这种预测价值尤为明显。手术后 3 年内，这些患者中没有一人存活。在其余三种评分系统中，高危患者的 3 年生存率>50%。
在我们的患者队列中，只有 MSKCC 和 Iwatsuki 评分能够预测生存情况。这些发现强调了在独立患者群体中验证评分系统的重要性。
