Melanie E Tsang1,2, Alyson L Mahar3, Guillaume Martel4,5, Sean P Cleary2,6, Sulaiman Nanji7,8, Jean-François Ouellet9,10, Roberto Hernandez-Alejandro11,12, Alice C Wei2,6, Julie Hallet2,13. 1. Department of Surgery, St. Joseph's Health Centre, Toronto, Ontario, Canada. 2. Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 3. Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. 4. Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada. 5. Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada. 6. Department of Surgery, University Health Network, Toronto, Ontario, Canada. 7. Department of Surgery, Queen's University, Kingston, Ontario, Canada. 8. Department of Surgery, Kingston Health Sciences Centre, Kingston, Ontario, Canada. 9. Department of Surgery, Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada. 10. Department of Surgery, Université Laval, Québec, Québec, Canada. 11. Department of Surgery, University of Western Ontario, London, Ontario, Canada. 12. Divison of Transplantation and Hepatobiliary Surgery, University of Rochester, Rochester, New York. 13. Department of Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada.
Abstract
INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
INTRODUCTION: 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. METHODS: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. RESULTS: 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. CONCLUSION: 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.
Authors: Ali Bohlok; Valerio Lucidi; Fikri Bouazza; Ali Daher; Desislava Germanova; Jean Luc Van Laethem; Alain Hendlisz; Vincent Donckier Journal: World J Surg Oncol Date: 2020-05-25 Impact factor: 2.754