Sasaki Kazunari, Morioka Daisuke, Conci Simone, Margonis Georgios A, Sawada Yu, Ruzzenente Andrea, Kumamoto Takafumi, Iacono Calogero, Andreatos Nikolaos, Guglielmi Alfredo, Endo Itaru, Pawlik Timothy M
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Ann Surg. 2018 Jan;267(1):132-141. doi: 10.1097/SLA.0000000000002064.
To apply the principles of the Metro-ticket paradigm to develop a prognostic model for patients undergoing hepatic resection of colorectal liver metastasis (CRLM).
Whereas the hepatocellular "Metro-ticket" prognostic tool utilizes a continuum of tumor size and number, a similar concept of a CRLM Metro-ticket paradigm has not been investigated.
Tumor Burden Score (TBS) was defined using distance from the origin on a Cartesian plane incorporating maximum tumor size (x-axis) and number of lesions (y-axis). The discriminatory power [area under the curve (AUC)] and goodness-of-fit (Akaike information criteria) of the TBS model versus standard tumor morphology categorization were assessed. The TBS model was validated using 2 external cohorts from Asia and Europe.
TBS (AUC 0.669) out-performed both maximum tumor size (AUC 0.619) and number of tumors (AUC 0.595) in predicting overall survival (OS) (P < 0.05). As TBS increased, survival incrementally worsened (5-year OS: zone 1, zone 2, and zone 3-68.9%, 49.4%, and 25.5%; P < 0.05). The stratification of survival based on traditional tumor size and number cut-off criteria was poor. Specifically, 5-year survival for patients in category 1, category 2, and category 3 was 58.3%, 45.5%, and 50.6%, respectively (P > 0.05). The corrected Akaike score information criteria value of the TBS model (2865) was lower than the traditional tumor morphologic categorization model (2905). Survival analysis revealed excellent prognostic discrimination for the TBS model among patients in both external cohorts (P< 0.05).
An externally validated "Metro-ticket" TBS model had excellent prognostic discriminatory power. TBS may be an accurate tool to account for the impact of tumor morphology on long-term survival among patients undergoing resection of CRLM.
应用地铁票范式的原则，为接受结直肠癌肝转移（CRLM）肝切除术的患者开发一种预后模型。
肝细胞癌的“地铁票”预后工具利用肿瘤大小和数量的连续体，但尚未研究CRLM地铁票范式的类似概念。
肿瘤负荷评分（TBS）通过在笛卡尔平面上从原点起的距离来定义，该平面纳入最大肿瘤大小（x轴）和病变数量（y轴）。评估TBS模型与标准肿瘤形态分类相比的鉴别能力[曲线下面积（AUC）]和拟合优度（赤池信息准则）。使用来自亚洲和欧洲的2个外部队列对TBS模型进行验证。
在预测总生存期（OS）方面，TBS（AUC 0.669）优于最大肿瘤大小（AUC 0.619）和肿瘤数量（AUC 0.595）（P < 0.05）。随着TBS增加，生存率逐渐恶化（5年总生存期：1区、2区和3 - 6区分别为68.9%、49.4%和25.5%；P < 0.05）。基于传统肿瘤大小和数量截断标准的生存分层较差。具体而言，1类、2类和3类患者的5年生存率分别为58.3%、45.5%和50.6%（P > 0.05）。TBS模型的校正赤池评分信息准则值（286５）低于传统肿瘤形态分类模型（2905）。生存分析显示，在两个外部队列的患者中，TBS模型具有出色的预后鉴别能力（P < 0.05）。
经过外部验证的“地铁票”TBS模型具有出色的预后鉴别能力。TBS可能是一种准确的工具，用于评估肿瘤形态对接受CRLM切除术患者长期生存的影响。
