• G E Wensink, Karen Bolhuis, Marloes A G Elferink, FijnemanRemond J ARJADepartment of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands., Onno Kranenburg, Borel RinkesInne H MIHMDepartment of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands., Miriam Koopman, Rutger-Jan Swijnenburg, Geraldine R Vink, Jeroen Hagendoorn, PuntCornelis J ACJADepartment of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands., Jeanine M L Roodhart, and Sjoerd G Elias.
• Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
• Br J Surg. 2023 Feb 15; 110 (3): 362371362-371.

BackgroundPatients who develop early extrahepatic recurrence (EHR) may not benefit from local treatment of colorectal liver metastases (CRLMs). This study aimed to develop a prediction model for early EHR after local treatment of CRLMs using a national data set.MethodsA Cox regression prediction model for EHR was developed and validated internally using data on patients who had local treatment for CRLMs with curative intent. Performance assessment included calibration, discrimination, net benefit, and generalizability by internal-external cross-validation. The prognostic relevance of early EHR (within 6 months) was evaluated by landmark analysis.ResultsDuring a median follow-up of 35 months, 557 of the 1077 patients had EHR and 249 died. Median overall survival was 19.5 (95 per cent c.i. 15.6 to 23.0) months in patients with early EHR after CRLM treatment, compared with not reached (45.3 months to not reached) in patients without an early EHR. The EHR prediction model included side and stage of the primary tumour, RAS/BRAFV600E mutational status, and number and size of CRLMs. The range of 6-month EHR predictions was 5.9-56.0 (i.q.r. 12.9-22.0) per cent. The model demonstrated good calibration and discrimination. The C-index through 6 and 12 months was 0.663 (95 per cent c.i. 0.624 to 0.702) and 0.661 (0.632 to 0.689) respectively. The observed 6-month EHR risk was 6.5 per cent for patients in the lowest quartile of predicted risk compared with 32.0 per cent in the highest quartile.ConclusionEarly EHR after local treatment of CRLMs can be predicted.© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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