Preoperative Prognostic Score for Predicting Survival After Hepatic Resection for Colorectal Liver Metastases

Abstract

In Brief Background: Despite indications for resection of colorectal liver metastases having expanded, debate continues about identifying patients that may benefit from surgery. Methods: Clinicopathologic data from a total of 700 patients was gathered between January 1993 and January 2006 from a prospectively maintained dataset. Of these, 687 patients underwent resection for colorectal liver metastases. Results: The median age of patient was 64 years and 36.8% of patients had synchronous disease. The overall 5-year survival was 45%. The presence of an inflammatory response to tumor (IRT), defined by an elevated C-reactive protein (>10 mg/L) or a neutrophil/lymphocyte ratio of >5:1, was noted in 24.5% of cases. Only the number of metastases and the presence or absence of an IRT influenced both overall and disease-free survival on multivariable analysis. A preoperative prognostic score was derived: 0 = less than 8 metastases and absence of IRT; 1 = 8 or more metastases or IRT, and 2 = 8 or more metastases and IRT—from the results of the multivariable analysis. The 5-year survival of those scoring 0 was 49% compared with 34% for those scoring 1. None of the patients that scored 2 were alive at 5 years. Conclusion: The preoperative prognostic score is a simple and effective system allowing preoperative stratification. Clinicopathologic review of patients undergoing liver resection for colorectal liver metastases identified 2 factors, namely 8 or more metastases and an inflammatory response to tumor that adversely influence outcome. The derived prognostic score can be calculated preoperatively, allowing clinicians to optimize patient care.