Tsang Melanie E, Mahar Alyson L, Martel Guillaume, Cleary Sean P, Nanji Sulaiman, Ouellet Jean-François, Hernandez-Alejandro Roberto, Wei Alice C, Hallet Julie
Department of Surgery, St. Joseph's Health Centre, Toronto, Ontario, Canada.
Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
J Surg Oncol. 2018 Nov;118(6):1006-1011. doi: 10.1002/jso.25228. Epub 2018 Sep 9.
Selection criteria and benefits for resection of noncolorectal, nonneuroendocrine liver metastases (NCNNELM) remain debated. A prognostic score was developed by the Association Française de Chirurgie (AFC) for patient selection, but not validated. We performed a geographic external validation of this score.
Patients with resected NCNNELM from six institutions (2000-2014) were assigned risk groups based on the AFC score. Discrimination was evaluated by visually inspecting separation of overall survival (OS) curves among risk categories. The slope of the continuous score on OS and hazard ratios for risk categories were examined.
Of 165 patients, 53 (32.1%) were low-risk, 85 (51.5%) intermediate-risk, and 27 (16.4%) high-risk. The OS curves did not separate among risk groups: 5-year OS were 60.1% (low), 57.1% (intermediate), and 55.6% (high). The parameter estimate (0.02) indicated lower discrimination than in the AFC cohort. Hazard ratios of 1.05 (0.63 to 1.70) for low vs intermediate, 0.87 (0.46 to 1.64) for low vs high, and 0.83 (0.46 to 1.49) for intermediate vs. high, demonstrated lack of discrimination in OS among risk groups.
While long-term survival is achievable, discrimination of the AFC score is not maintained in a geographic external cohort of resected NCNNELM. It is not generalizable to this external population.
非结直肠癌、非神经内分泌肝转移瘤（NCNNELM）切除的选择标准和益处仍存在争议。法国外科协会（AFC）制定了一个预后评分用于患者选择，但尚未得到验证。我们对该评分进行了地理外部验证。
对来自六个机构（2000 - 2014年）的接受NCNNELM切除的患者根据AFC评分进行风险分组。通过直观检查风险类别之间总生存（OS）曲线的分离情况来评估辨别力。检查了OS上连续评分的斜率以及风险类别的风险比。
165例患者中，53例（32.1%）为低风险，85例（51.5%）为中等风险，27例（16.4%）为高风险。OS曲线在风险组之间没有分离：5年总生存率分别为60.1%（低风险）、57.1%（中等风险）和55.6%（高风险）。参数估计值（0.02）表明辨别力低于AFC队列。低风险与中等风险的风险比为1.05（0.63至1.70），低风险与高风险的风险比为0.87（0.46至1.64），中等风险与高风险的风险比为0.83（0.46至1.49），表明风险组之间在OS方面缺乏辨别力。
虽然可以实现长期生存，但在接受NCNNELM切除的地理外部队列中，AFC评分的辨别力无法维持。它不适用于这个外部人群。
