Clinical Research Papers:
A postoperative scoring system for post-hepatectomy early recurrence of colorectal liver metastases
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Rui Mao1,*, Jian-Jun Zhao1,*, Xin-Yu Bi1,*, Ye-Fan Zhang1, Zhi-Yu Li1, Jian-Guo Zhou1, Xiao-Long Wu1, Chen Xiao1, Hong Zhao1 and Jian-Qiang Cai1
1Department of Hepatobiliary Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
*These authors contributed equally to this work
Jian-Qiang Cai, email: [email protected]
Hong Zhao, email: [email protected]
Keywords: colorectal liver metastases, hepatectomy, early recurrence, risk factors, salvage treatment
Received: August 08, 2017 Accepted: August 28, 2017 Published: September 15, 2017
The aims of this study were to assess early recurrence predictive factors and elucidate the best early recurrence management. 255 patients with colorectal liver metastases (CRLM) who underwent hepatectomy were retrospectively analyzed. A total of 87 patients (34.1%) developed early recurrence, defined as recurrence that occurred within 6 months after resection. Multivariate analysis showed that preoperative carcino-embryonic antigen (CEA) level ≥ 30 ng/ml, primary tumor lymphovascular invasion (LVI), number of metastases ≥ 4, R1 resection and initially unresectable disease were independent predictors of early recurrence. A predictive scoring system for early recurrence was created by incorporating these factors, and this system showed good discrimination (concordance index of 0.78). In early recurrent patients who underwent salvage treatment, those with 0–2 risk factors demonstrated a significantly longer median survival after recurrence than patients with 3–5 risk factors (33.4 months vs. 20.2 months, p = 0.001). For patients who underwent chemotherapy alone, the median survival after recurrence between two groups was comparable (18.3 months vs. 22.6 months, p = 0.926). Multivariate analysis revealed that primary tumor lymph node metastases (HR = 1.96, p = 0.032), early recurrence (HR = 1.67, p = 0.045), salvage treatment for recurrence (HR = 0.47, p = 0.002) and predictive scores for early recurrence (HR = 1.39, p = 0.004) were independent factors for survival in patients with recurrence. In patients with early recurrence, bilobar distribution of metastases (HR = 2.05, p = 0.025) and salvage treatment for recurrence (HR = 0.46, p = 0.019) were independent factors for survival. In conclusion, we developed a predictive model that is a very useful tool for determining both the likelihood of early recurrence and the necessity for salvage treatment.
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