Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Hepatopancreatobiliary Surgery Department I, Beijing, PR China.
Harbin Medical University Cancer Hospital, Department of Internal Medicine of Digestive Tumor, Harbin, Heilongjiang Province, PR China.
Eur J Surg Oncol. 2019 Nov;45(11):2070-2077. doi: 10.1016/j.ejso.2019.06.033. Epub 2019 Jun 25.
Hepatic resection is regarded to as a potentially curative option for colorectal cancer liver metastases (CRLM), but it is associated with a high rate of recurrence. The present study intended to establish an effective nomogram to predict disease free survival (DFS) and select candidates of hepatic resection.
The nomogram was based on a retrospective study on 447 CRLM patients treated with preoperative chemotherapy followed by hepatic resection using a multicentric database between January 1st, 2010 and December 31st, 2017. Results were validated using bootstrap resampling on 117 patients. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index (C-index) and calibration curve. Overall survival, disease free survival, and local recurrence rate for patients with colorectal cancer were measured.
Based on multivariate analysis of the primary cohort, independent factors for DFS included tumor size larger than 5 cm, multiple liver metastases(>1), RAS mutation, primary lymph node metastasis and tumor size increase after preoperative chemotherapy. These five factors were all considered in the nomogram. The C-index of the nomogram for predicting survival was 0.675. With external validation, the C-index of the nomogram for the prediction of the DFS was 0.77, which demonstrated that this model has a good level of discriminative ability. For the 382 patients (66.7%) who developed recurrence, the optimal cutoff point for early recurrence was determined to be 12 months after hepatic resection.
The proposed nomogram demonstrated accurate prognostic prediction of DFS for CRLM patients with preoperative chemotherapy followed by hepatic resection.
肝切除术被认为是结直肠癌肝转移（CRLM）的一种潜在治愈方法，但它与高复发率相关。本研究旨在建立一种有效的列线图，以预测无病生存（DFS）并选择肝切除术的候选者。
该列线图基于 2010 年 1 月 1 日至 2017 年 12 月 31 日期间，使用多中心数据库对接受术前化疗后行肝切除术的 447 例 CRLM 患者进行的回顾性研究。使用 117 例患者的 bootstrap 重采样对结果进行验证。通过一致性指数（C 指数）和校准曲线来确定列线图的预测准确性和判别能力。测量了接受肝切除术的结直肠癌患者的总生存、无病生存和局部复发率。
基于主要队列的多变量分析，DFS 的独立因素包括肿瘤大小大于 5cm、多个肝转移（>1）、RAS 突变、原发淋巴结转移和术前化疗后肿瘤大小增加。这些五个因素均被纳入列线图。该列线图预测生存的 C 指数为 0.675。外部验证中，该列线图预测 DFS 的 C 指数为 0.77，表明该模型具有良好的判别能力。对于 382 例（66.7%）发生复发的患者，确定肝切除后 12 个月是早期复发的最佳截断点。
该列线图为接受术前化疗后行肝切除术的 CRLM 患者提供了准确的 DFS 预后预测。
