OBJECTIVE: To identify risk factors associated with cancer-specific survival and develop a predictive model for patients undergoing primary hepatic resection for metastatic colorectal cancer. BACKGROUND: No published studies investigated collectively the inter-relation of factors related to patient cancer-specific survival after hepatectomy for metastatic colorectal cancer. METHODS: Clinical, pathologic, and complete follow-up data were prospectively collected from 929 consecutive patients undergoing primary (n = 925) or repeat hepatic resection (n = 80) for colorectal liver metastases at a tertiary referral center from 1987 to 2005. Parametric survival analysis was used to identify predictors of cancer-specific survival and develop a predictive model. The model was validated using measures of discrimination and calibration. RESULTS: Postoperative mortality and morbidity were 1.5% and 25.9%, respectively. 5-year and 10-year cancer-specific survival were 36% and 23%. On multivariate analysis, 7 risk factors were found to be independent predictors of poor survival: number of hepatic metastases >3, node positive primary, poorly differentiated primary, extrahepatic disease, tumor diameter > or =5 cm, carcinoembryonic antigen level >60 ng/mL, and positive resection margin. The first 6 of these criteria were used in a preoperative scoring system and the last 6 in the postoperative setting. Patients with the worst postoperative prognostic criteria had an expected median cancer-specific survival of 0.7 years and a 5-year cancer-specific survival of 2%. Conversely, patients with the best prognostic postoperative criteria had an expected median cancer-specific survival of 7.4 years and a 5-year cancer-specific survival of 64%. When tested both predictive models fitted the data well with no significant differences between observed and predicted outcomes (P > 0.05). CONCLUSION: Resection of liver metastases provides good long-term cancer-specific survival benefit, which can be quantified pre- or postoperatively using the criteria described. The "Basingstoke Predictive Index" may be used for risk-stratifying patients who may benefit from intensive surveillance and selection for adjuvant therapy and trials.
OBJECTIVE: To identify risk factors associated with cancer-specific survival and develop a predictive model for patients undergoing primary hepatic resection for metastatic colorectal cancer. BACKGROUND: No published studies investigated collectively the inter-relation of factors related to patientcancer-specific survival after hepatectomy for metastatic colorectal cancer. METHODS: Clinical, pathologic, and complete follow-up data were prospectively collected from 929 consecutive patients undergoing primary (n = 925) or repeat hepatic resection (n = 80) for colorectal liver metastases at a tertiary referral center from 1987 to 2005. Parametric survival analysis was used to identify predictors of cancer-specific survival and develop a predictive model. The model was validated using measures of discrimination and calibration. RESULTS: Postoperative mortality and morbidity were 1.5% and 25.9%, respectively. 5-year and 10-year cancer-specific survival were 36% and 23%. On multivariate analysis, 7 risk factors were found to be independent predictors of poor survival: number of hepatic metastases >3, node positive primary, poorly differentiated primary, extrahepatic disease, tumor diameter > or =5 cm, carcinoembryonic antigen level >60 ng/mL, and positive resection margin. The first 6 of these criteria were used in a preoperative scoring system and the last 6 in the postoperative setting. Patients with the worst postoperative prognostic criteria had an expected median cancer-specific survival of 0.7 years and a 5-year cancer-specific survival of 2%. Conversely, patients with the best prognostic postoperative criteria had an expected median cancer-specific survival of 7.4 years and a 5-year cancer-specific survival of 64%. When tested both predictive models fitted the data well with no significant differences between observed and predicted outcomes (P > 0.05). CONCLUSION: Resection of liver metastases provides good long-term cancer-specific survival benefit, which can be quantified pre- or postoperatively using the criteria described. The "Basingstoke Predictive Index" may be used for risk-stratifying patients who may benefit from intensive surveillance and selection for adjuvant therapy and trials.
Authors: Michel Gonzalez; John Henri Robert; Nermin Halkic; Gilles Mentha; Arnaud Roth; Thomas Perneger; Hans Beat Ris; Pascal Gervaz Journal: World J Surg Date: 2012-02 Impact factor: 3.352
Authors: Alec H Engledow; James R A Skipworth; Farrokh Pakzad; Charles Imber; Peter J Ell; Ashley M Groves Journal: HPB (Oxford) Date: 2011-11-14 Impact factor: 3.647
Authors: Amber L Simpson; Alexandre Doussot; John M Creasy; Lauryn B Adams; Peter J Allen; Ronald P DeMatteo; Mithat Gönen; Nancy E Kemeny; T Peter Kingham; Jinru Shia; William R Jarnagin; Richard K G Do; Michael I D'Angelica Journal: Ann Surg Oncol Date: 2017-05-30 Impact factor: 5.344
Authors: E P van der Stok; M Smid; A M Sieuwerts; P B Vermeulen; S Sleijfer; N Ayez; D J Grünhagen; J W M Martens; C Verhoef Journal: Mol Oncol Date: 2016-09-20 Impact factor: 6.603
Authors: Ilia Gur; Brian S Diggs; Jesse A Wagner; Gina M Vaccaro; Charles D Lopez; Brett C Sheppard; Susan L Orloff; Kevin G Billingsley Journal: J Gastrointest Surg Date: 2013-10-04 Impact factor: 3.452