Premium
Clinical risk scores in the current era of neoadjuvant chemotherapy for colorectal liver metastases
Author(s) -
Kumar Rohan,
Dennison Ashley R.,
Robertson Vaux,
Jones Michael J.,
Neal Christopher P.,
Garcea Giuseppe
Publication year - 2016
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13688
Subject(s) - medicine , carcinoembryonic antigen , chemotherapy , neoadjuvant therapy , oncology , multivariate analysis , colorectal cancer , context (archaeology) , confidence interval , cancer , paleontology , breast cancer , biology
Background Clinical risk scores ( CRS ) within the context of neoadjuvant chemotherapy for colorectal liver metastases ( CRLM ) has not been validated. The predictive value of clinical risk scoring in patients administered neoadjuvant chemotherapy prior to liver surgery for CRLM is evaluated. Methods A prospective database over a 15‐year period (April 1999 to March 2014) was analysed. We identified two groups: A, neoadjuvant chemotherapy prior to CRLM surgery; and B, no neoadjuvant chemotherapy. Results Overall median survival in groups A and B were 36 (2–137) months and 33 (2–137) months. In group A, nodal status, size, number of metastases and carcinoembryonic antigen levels were not found to be independent predictors of overall survival (OS). However, patients with a shorter disease‐free interval of less than 12 months had an increased OS ( P = 0.0001). Multivariate analysis of high‐ and low‐risk scores compared against survival in group B ( P < 0.05) confirms the applicability of the scoring system in traditional settings. Conclusion Traditional CRS are not a prognostic predictive tool when applied to patients receiving neoadjuvant chemotherapy for CRLM . Disease‐free interval may be one independent variable for use in future risk score systems specifically developed for the neoadjuvant chemotherapy era.