• Liver Int. · Jan 2009

    Comparative Study

    Prognostic factors and evaluation of a clinical score for predicting survival after resection of colorectal liver metastases.

    • Ralf Konopke, Stephan Kersting, Marius Distler, Jeannine Dietrich, Jörg Gastmeier, Axel Heller, Eberhard Kulisch, and Hans-Detlev Saeger.
    • Department of General, Thoracic and Vascular Surgery, University of Technology, Dresden, Germany. ralf.konopke@uniklinikum-dresden.de
    • Liver Int. 2009 Jan 1; 29 (1): 89-102.

    BackgroundPatient outcome after resection of colorectal liver metastases can be predicted by various prognostic factors.AimsDevelopment of a model for risk stratification based on analysis of prognostic factors.MethodsData of 201 patients were collected prospectively and included in a single-centre trial. A total of 20 factors were analysed as to their influence on recurrence-free and overall survival. Independent prognostic factors were entered into a model of a clinical risk score.ResultsMedian recurrence-free survival reached 24 months for all patients; median overall survival was 50 months. Only a synchronous manifestation of primary colorectal carcinoma and liver metastases, the presence of four or more metastases and a carcino-embryonic antigen level of 200 ng/ml or more significantly influenced recurrence-free and overall survival in the multivariate analysis. The derived risk stratification grouped the patients according to the following criteria: low risk, zero prognostic factors (n=112); intermediate risk, one factor (n=74); high risk, two or more factors (n=15). The median recurrence-free survival for low, intermediate and high risk were 30.0, 23.0 and 11.0 months, respectively; the median overall survival was 94.0, 40.0 and 33.0 months. Compared with the low-risk group, patients with intermediate risk demonstrated an increased hazard ratio (HR) of 1.57-fold for recurrence (P=0.018) and 1.91-fold for mortality (P=0.007). For the high-risk group, the HR rose significantly to 3.26 for recurrence (P<0.0005) and to 3.10 for mortality (P=0.001).ConclusionsThe presented clinical score may allow for patients with colorectal liver metastases to be stratified appropriately and for optimization of their subsequent therapeutic management.

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