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Prognostic factors and evaluation of a clinical score for predicting survival after resection of colorectal liver metastases

Authors


Correspondence
Ralf Konopke, MD, Department of General, Thoracic and Vascular Surgery, University of Technology, Fetscherstr. 74, 01307 Dresden, Germany
Tel: +49 351 458 4880
Fax: +49 351 449 210 301
e-mail: ralf.konopke@uniklinikum-dresden.de

Abstract

Background: Patient outcome after resection of colorectal liver metastases can be predicted by various prognostic factors.

Aims: Development of a model for risk stratification based on analysis of prognostic factors.

Methods: Data of 201 patients were collected prospectively and included in a single-centre trial. A total of 20 factors were analysed as to their influence on recurrence-free and overall survival. Independent prognostic factors were entered into a model of a clinical risk score.

Results: Median recurrence-free survival reached 24 months for all patients; median overall survival was 50 months. Only a synchronous manifestation of primary colorectal carcinoma and liver metastases, the presence of four or more metastases and a carcino-embryonic antigen level of 200 ng/ml or more significantly influenced recurrence-free and overall survival in the multivariate analysis. The derived risk stratification grouped the patients according to the following criteria: low risk, zero prognostic factors (n=112); intermediate risk, one factor (n=74); high risk, two or more factors (n=15). The median recurrence-free survival for low, intermediate and high risk were 30.0, 23.0 and 11.0 months, respectively; the median overall survival was 94.0, 40.0 and 33.0 months. Compared with the low-risk group, patients with intermediate risk demonstrated an increased hazard ratio (HR) of 1.57-fold for recurrence (P=0.018) and 1.91-fold for mortality (P=0.007). For the high-risk group, the HR rose significantly to 3.26 for recurrence (P<0.0005) and to 3.10 for mortality (P=0.001).

Conclusions: The presented clinical score may allow for patients with colorectal liver metastases to be stratified appropriately and for optimization of their subsequent therapeutic management.

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