Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Division of Surgery, Department for Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
BJS Open. 2021 Sep 6;5(5). doi: 10.1093/bjsopen/zrab104.
Several existing scoring systems predict survival of patients with colorectal liver metastases. Many lack validation, rely on old clinical data, and have been found to be less accurate since the introduction of chemotherapy. This study aimed to construct and validate a clinically relevant preoperative prognostic model for patients with colorectal liver metastases.
A predictive model with data available before surgery was developed. Survival was analysed by Cox regression analysis, and the quality of the model was assessed using discrimination and calibration. The model was validated using multifold cross-validation.
The model included 1212 consecutive patients who underwent liver resection for colorectal liver metastases between 2005 and 2015. Prognostic factors for survival included advanced age, raised C-reactive protein level, hypoalbuminaemia, extended liver resection, larger number of metastases, and midgut origin of the primary tumour. A Composite Score was developed based on the prognostic variables. Patients were classified into those at low, medium, and high risk. Survival differences between the groups were significant; median overall survival was 87.4 months in the low-risk group, 50.1 months in the medium-risk group, and 22.6 months in the high-risk group. The discriminative performance, assessed by the concordance index, was 0.71, 0.67, and 0.67 respectively at 1, 3, and 5 years. Calibration, assessed graphically, was close to perfect. A multifold cross-validation of the model confirmed its internal validity (C-index 0.63 versus 0.62).
The Composite Score categorizes patients into risk strata, and may help identify patients who have a poor prognosis, for whom surgery is questionable.
有几种现有的评分系统可预测结直肠癌肝转移患者的生存情况。许多评分系统缺乏验证，依赖于旧的临床数据，并且自化疗引入以来发现其准确性降低。本研究旨在构建和验证一种针对结直肠癌肝转移患者的具有临床相关性的术前预后模型。
开发了一个具有手术前可用数据的预测模型。通过 Cox 回归分析对生存情况进行分析，并通过区分度和校准来评估模型的质量。使用多重交叉验证验证模型。
该模型纳入了 2005 年至 2015 年间接受肝切除术治疗结直肠癌肝转移的 1212 例连续患者。生存的预后因素包括年龄较大、C 反应蛋白水平升高、低白蛋白血症、广泛肝切除术、转移灶数量较多以及原发性肿瘤起源于中肠。根据预后变量开发了一个综合评分。患者被分为低危、中危和高危组。组间生存差异显著；低危组的中位总生存期为 87.4 个月，中危组为 50.1 个月，高危组为 22.6 个月。通过一致性指数评估的区分性能分别为 0.71、0.67 和 0.67，分别在 1、3 和 5 年。通过图形评估的校准接近完美。模型的多重交叉验证证实了其内部有效性（C 指数为 0.63 与 0.62）。
综合评分将患者分为风险分层，这可能有助于识别预后不良的患者，对于这些患者，手术可能存在疑问。
