A comparison of clinical risk scores for survival prediction after curative-intent resection of colorectal liver metastases.

Introduction Clinical risk scores (CRS) have been developed to predict overall survival (OS), after liver resection for colorectal liver metastases (CRLM). In this study, we compare 11 previously described CRS on a monocentric cohort.

Method This retrospective study included patients, who underwent liver resection for CRLM between 2010-2021. Recurrent metastases, explorative laparotomies and patients dying within 90 days of surgery were excluded. The following 11 CRS were assessed: Fong, Nordlinger, Nagashima, Konopke, Basingstoke Predictive Index (BPI), tumour burden score (TBS), resection severity index (RSI), Kulik, RAS-mutation-CRS, modified TBS (mTBS), genetic and morpholigal evaluation (GAME) score. Survival was analysed using Kaplan-Meier and the log-rank test. Predictive abilities were evaluated using the Akaike-Information-Criterion (AIC), Harrell’s-C-Index, and AUC-analyses.

Results Median OS for 528 included patients was 26 months (95% CI 23-28 months). Apart from RSI (p=0.570), all other CRS could stratify patients according to predicted OS: Fong, p=0.007; Nordlinger, p<0.001; GAME-score, p=0.006; Nagashima, p<0.001; Konopke, p<0.001; BPI, p<0.001; TBS, p<0.001; Kulik, p<0.001; RAS-mutation-CRS, p<0.001; mTBS, p<0.001. mTBS consistently performed within the top 3 scores for OS (AIC 1725, C-Index 0.61), while TBS (AUC=0.654, p=0.001) and mTBS (AUC=0.62, p<0.001) were the best for 1-year- and 5-year-survival, respectively.

Conclusion Of 11 externally developed and validated CRS, the mTBS was consistently among the best, in terms of OS prediction. Further studies are neccesary to elucidate the effect of factors such as tumor biology.

Publikationsverlauf

Artikel online veröffentlicht:
23. Januar 2024