Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Br J Surg. 2018 Aug;105(9):1210-1220. doi: 10.1002/bjs.10838. Epub 2018 Apr 25.
This study sought to develop a clinical risk score for resectable colorectal liver metastasis (CRLM) by combining clinicopathological and clinically available biological indicators, including KRAS.
A cohort of patients who underwent resection for CRLM at the Johns Hopkins Hospital (JHH) was analysed to identify independent predictors of overall survival (OS) that can be assessed before operation; these factors were combined into the Genetic And Morphological Evaluation (GAME) score. The score was compared with the current standard (Fong score) and validated in an external cohort of patients from the Memorial Sloan Kettering Cancer Center (MSKCC).
Six preoperative predictors of worse OS were identified on multivariable Cox regression analysis in the JHH cohort (502 patients). The GAME score was calculated by allocating points to each patient according to the presence of these predictive factors: KRAS-mutated tumours (1 point); carcinoembryonic antigen level 20 ng/ml or more (1 point), primary tumour lymph node metastasis (1 point); Tumour Burden Score between 3 and 8 (1 point) or 9 and over (2 points); and extrahepatic disease (2 points). The high-risk group in the JHH cohort (GAME score at least 4 points) had a 5-year OS rate of 11 per cent, compared with 73·4 per cent for those in the low-risk group (score 0-1 point). Importantly, in cohorts from both the JHH and MSKCC (747 patients), the discriminatory capacity of the GAME score was superior to that of the Fong score, as demonstrated by the C-index and the Akaike information criterion.
The GAME score is a preoperative prognostic tool that can be used to inform treatment selection.
本研究旨在通过结合临床病理和临床可用的生物学指标，包括 KRAS，为可切除结直肠癌肝转移（CRLM）建立临床风险评分。
分析约翰霍普金斯医院（JHH）接受 CRLM 切除术的患者队列，以确定可在术前评估的总生存（OS）的独立预测因素；这些因素被合并到遗传和形态评估（GAME）评分中。该评分与当前标准（Fong 评分）进行比较，并在 Memorial Sloan Kettering 癌症中心（MSKCC）的外部患者队列中进行验证。
多变量 Cox 回归分析确定了 JHH 队列中 6 个与较差 OS 相关的术前预测因素（502 例患者）。GAME 评分通过根据这些预测因素的存在为每位患者分配分数来计算：KRAS 突变型肿瘤（1 分）；癌胚抗原水平 20ng/ml 或更高（1 分）、原发肿瘤淋巴结转移（1 分）；肿瘤负担评分 3-8（1 分）或 9 分及以上（2 分）；以及肝外疾病（2 分）。JHH 队列中的高危组（GAME 评分至少为 4 分）的 5 年 OS 率为 11%，而低危组（评分 0-1 分）的 5 年 OS 率为 73.4%。重要的是，在 JHH 和 MSKCC 的队列中（747 例患者），GAME 评分的判别能力优于 Fong 评分，这体现在 C 指数和 Akaike 信息准则上。
GAME 评分是一种术前预后工具，可用于指导治疗选择。
