Wei Liu1, Kun Wang1, Yu Han2, Jie-Ying Liang3, Yu-Hong Li4, Bao-Cai Xing5. 1. 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. 2. Harbin Medical University Cancer Hospital, Department of Internal Medicine of Digestive Tumor, Harbin, Heilongjiang Province, PR China. 3. Sun Yat-sen University Oncology Hospital, Department of Internal Medicine of Digestive Tumor, Guangzhou, Guangdong Province, PR China. 4. Sun Yat-sen University Oncology Hospital, Department of Internal Medicine of Digestive Tumor, Guangzhou, Guangdong Province, PR China. Electronic address: liyh@sysucc.org.cn. 5. 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. Electronic address: xingbaocai88@sina.com.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: The proposed nomogram demonstrated accurate prognostic prediction of DFS for CRLM patients with preoperative chemotherapy followed by hepatic resection.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: The proposed nomogram demonstrated accurate prognostic prediction of DFS for CRLM patients with preoperative chemotherapy followed by hepatic resection.
Authors: Florian E Buisman; Daniele Giardiello; Nancy E Kemeny; Ewout W Steyerberg; Diederik J Höppener; Boris Galjart; Pieter M H Nierop; Vinod P Balachandran; Andrea Cercek; Jeffrey A Drebin; Mithat Gönen; William R Jarnagin; T P Kingham; Peter B Vermeulen; Alice C Wei; Dirk J Grünhagen; Cornelis Verhoef; Micheal I D'Angelica; Bas Groot Koerkamp Journal: Eur J Cancer Date: 2022-04-14 Impact factor: 10.002