TY - JOUR
T1 - Nontumor related risk score
T2 - A new tool to improve prediction of prognosis after hepatectomy for colorectal liver metastases
AU - Sasaki, Kazunari
AU - Margonis, Georgios Antonios
AU - Moro, Amika
AU - Wang, Jane
AU - Wagner, Doris
AU - Gagnière, Johan
AU - Shin, Jung Kyong
AU - D'Silva, Mizelle
AU - Sahara, Kota
AU - Miyata, Tatsunori
AU - Kusakabe, Jiro
AU - Beyer, Katharina
AU - Dupré, Aurélien
AU - Kamphues, Carsten
AU - Imai, Katsunori
AU - Baba, Hideo
AU - Endo, Itaru
AU - Taura, Kojiro
AU - Cho, Jai Young
AU - Aucejo, Federico
AU - Kornprat, Peter
AU - Kreis, Martin E.
AU - Kim, Jong Man
AU - Burkhart, Richard
AU - David Kwon, Choon Hyuck
AU - Pawlik, Timothy M.
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/6
Y1 - 2022/6
N2 - Background: Prognostic stratification of patients with colorectal cancer liver metastasis based solely on tumor-related factors has only moderate discriminatory ability. We hypothesized that the inclusion of nontumor related factors can improve prediction of long-term prognosis of patients with colorectal cancer liver metastasis. Methods: Nontumor related laboratory markers were assessed utilizing a training cohort from 2 U.S. institutions (n = 1,205). Factors independently associated with prognosis were used to develop a nontumor related prognostic score. The discriminatory ability, assessed by Harrell's C-statistics (C-index) and net reclassification improvement, was validated and compared with 3 commonly used tumor-related clinical risk scores: Fong clinical risk scores, m-clinical risk scores, and Genetic and Morphological Evaluation (GAME) score in an external validation cohort from 5 Asian (n = 1,307) and 3 European (n = 1,058) institutions. The discriminatory ability of nontumor related prognostic score combined with each of these 3 tumor-related prognostic scores was also estimated. Results: Alkaline phosphatase (hazard ratio 1.43; 95% confidence interval, 1.11–1.84), albumin (hazard ratio 0.71; 95% confidence interval, 0.57–0.89), and mean corpuscular volume (hazard ratio 19.0, per log unit; 95% confidence interval, 4.79–75.0) were each independently associated with increased risk of death after resection of colorectal cancer liver metastasis (all P < .05). In turn, alkaline phosphatase, albumin, and mean corpuscular volume were combined to form a nontumor related prognostic score (2.942 × mean corpuscular volume + 0.399 × alkaline phosphatase-0.339 × albumin-12) × 10 (median, 16; range, 1–30). The nontumor related prognostic score had good-to-modest discriminatory ability in the external cohort (C-index = 0.58), which was comparable to the 3 established tumor-related prognostic scores (C-index: Fong clinical risk scores, 0.53, m-clinical risk scores, 0.55, GAME, 0.58). The addition of the nontumor related prognostic score to the tumor-related prognostic scores enhanced the discriminatory ability in the entire study cohort (C-index: nontumor related score+Fong, 0.60, nontumor related score+m-clinical risk scores, 0.61, nontumor related score+GAME, 0.64), as well reclassification improvement (42.5, 42.7%, and 21.2%, respectively). Conclusion: Nontumor related prognostic information may help improve the prognostic stratification of patients after resection of colorectal cancer liver metastasis. The nontumor related prognostic score may be combined with tumor-related prognostic tools to enhance prognostic stratification of patients with colorectal cancer liver metastasis.
AB - Background: Prognostic stratification of patients with colorectal cancer liver metastasis based solely on tumor-related factors has only moderate discriminatory ability. We hypothesized that the inclusion of nontumor related factors can improve prediction of long-term prognosis of patients with colorectal cancer liver metastasis. Methods: Nontumor related laboratory markers were assessed utilizing a training cohort from 2 U.S. institutions (n = 1,205). Factors independently associated with prognosis were used to develop a nontumor related prognostic score. The discriminatory ability, assessed by Harrell's C-statistics (C-index) and net reclassification improvement, was validated and compared with 3 commonly used tumor-related clinical risk scores: Fong clinical risk scores, m-clinical risk scores, and Genetic and Morphological Evaluation (GAME) score in an external validation cohort from 5 Asian (n = 1,307) and 3 European (n = 1,058) institutions. The discriminatory ability of nontumor related prognostic score combined with each of these 3 tumor-related prognostic scores was also estimated. Results: Alkaline phosphatase (hazard ratio 1.43; 95% confidence interval, 1.11–1.84), albumin (hazard ratio 0.71; 95% confidence interval, 0.57–0.89), and mean corpuscular volume (hazard ratio 19.0, per log unit; 95% confidence interval, 4.79–75.0) were each independently associated with increased risk of death after resection of colorectal cancer liver metastasis (all P < .05). In turn, alkaline phosphatase, albumin, and mean corpuscular volume were combined to form a nontumor related prognostic score (2.942 × mean corpuscular volume + 0.399 × alkaline phosphatase-0.339 × albumin-12) × 10 (median, 16; range, 1–30). The nontumor related prognostic score had good-to-modest discriminatory ability in the external cohort (C-index = 0.58), which was comparable to the 3 established tumor-related prognostic scores (C-index: Fong clinical risk scores, 0.53, m-clinical risk scores, 0.55, GAME, 0.58). The addition of the nontumor related prognostic score to the tumor-related prognostic scores enhanced the discriminatory ability in the entire study cohort (C-index: nontumor related score+Fong, 0.60, nontumor related score+m-clinical risk scores, 0.61, nontumor related score+GAME, 0.64), as well reclassification improvement (42.5, 42.7%, and 21.2%, respectively). Conclusion: Nontumor related prognostic information may help improve the prognostic stratification of patients after resection of colorectal cancer liver metastasis. The nontumor related prognostic score may be combined with tumor-related prognostic tools to enhance prognostic stratification of patients with colorectal cancer liver metastasis.
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U2 - 10.1016/j.surg.2022.01.030
DO - 10.1016/j.surg.2022.01.030
M3 - Article
C2 - 35221105
AN - SCOPUS:85125469593
SN - 0039-6060
VL - 171
SP - 1580
EP - 1587
JO - Surgery (United States)
JF - Surgery (United States)
IS - 6
ER -