Bai Long, Yan Xiao-Luan, Lu Yun-Xin, Meng Qi, Rong Yu-Ming, Ye Liu-Fang, Pan Zhi-Zhong, Xing Bao-Cai, Wang De-Shen
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China.
Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, 510060, People's Republic of China.
Ann Surg Oncol. 2022 Jan 4;29(7):4308-23. doi: 10.1245/s10434-021-11234-0.
Colorectal cancer liver metastasis (CRLM) is a determining factor affecting the survival of colorectal cancer (CRC) patients. This study aims at developing a novel prognostic stratification tool for CRLM resection.
In this retrospective study, 666 CRC patients who underwent complete CRLM resection from two Chinese medical institutions between 2001 and 2016 were classified into the training (341 patients) and validation (325 patients) cohorts. The primary endpoint was overall survival (OS). Associations between clinicopathological variables, circulating lipid and inflammation biomarkers, and OS were explored. The five most significant prognostic factors were incorporated into the Circulating Lipid- and Inflammation-based Risk (CLIR) score. The predictive ability of the CLIR score and Fong's Clinical Risk Score (CRS) was compared by time-dependent receiver operating characteristic (ROC) analysis.
Five independent predictors associated with worse OS were identified in the training cohort: number of CRLMs >4, maximum diameter of CRLM >4.4 cm, primary lymph node-positive, serum lactate dehydrogenase (LDH) level >250.5 U/L, and serum low-density lipoprotein-cholesterol (LDL-C)/high-density lipoprotein-cholesterol (HDL-C) ratio >2.9. These predictors were included in the CLIR score and each factor was assigned one point. Median OS for the low (score 0-1)-, intermediate (score 2-3)-, and high (score 4-5)-risk groups was 134.0 months, 39.9 months, and 18.7 months in the pooled cohort. The CLIR score outperformed the Fong score with superior discriminatory capacities for OS and RFS, both in the training and validation cohorts.
The CLIR score demonstrated a promising ability to predict the long-term survival of CRC patients after complete hepatic resection.
结直肠癌肝转移（CRLM）是影响结直肠癌（CRC）患者生存的决定性因素。本研究旨在开发一种用于CRLM切除的新型预后分层工具。
在这项回顾性研究中，2001年至2016年间在两家中国医疗机构接受CRLM完全切除的666例CRC患者被分为训练队列（341例患者）和验证队列（325例患者）。主要终点是总生存期（OS）。探讨临床病理变量、循环脂质和炎症生物标志物与OS之间的关联。将五个最显著的预后因素纳入基于循环脂质和炎症的风险（CLIR）评分。通过时间依赖性受试者工作特征（ROC）分析比较CLIR评分和方氏临床风险评分（CRS）的预测能力。
在训练队列中确定了五个与较差OS相关的独立预测因素：CRLM数量>4个、CRLM最大直径>4.4 cm、原发淋巴结阳性、血清乳酸脱氢酶（LDH）水平>250.5 U/L以及血清低密度脂蛋白胆固醇（LDL-C）/高密度脂蛋白胆固醇（HDL-C）比值>2.9。这些预测因素被纳入CLIR评分，每个因素赋予一分。在合并队列中，低风险（评分0 - 1）、中风险（评分2 - 3）和高风险（评分4 - 5）组的中位OS分别为134.0个月、39.9个月和18.7个月。在训练队列和验证队列中，CLIR评分在OS和无复发生存期（RFS）的鉴别能力方面均优于方氏评分。
CLIR评分显示出预测CRC患者肝完全切除术后长期生存的良好能力。
