Cheng KC, Yip ASM. Prognostic factors of survival and a new scoring system for liver resection of colorectal liver metastasis. World J Hepatol 2022; 14(1): 209-223 [PMID: 35126849 DOI: 10.4254/wjh.v14.i1.209]
Corresponding Author of This Article
Kai-Chi Cheng, FRCS (Ed), Doctor, Department of Surgery, Kwong Wah Hospital, No. 25 Waterloo Road, Kowloon, Hong Kong, China. thomascheng@hotmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Cohort Study
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Cheng KC, Yip ASM. Prognostic factors of survival and a new scoring system for liver resection of colorectal liver metastasis. World J Hepatol 2022; 14(1): 209-223 [PMID: 35126849 DOI: 10.4254/wjh.v14.i1.209]
World J Hepatol. Jan 27, 2022; 14(1): 209-223 Published online Jan 27, 2022. doi: 10.4254/wjh.v14.i1.209
Prognostic factors of survival and a new scoring system for liver resection of colorectal liver metastasis
Kai-Chi Cheng, Ada Sze-Man Yip
Kai-Chi Cheng, Ada Sze-Man Yip, Department of Surgery, Kwong Wah Hospital, Hong Kong, China
Author contributions: Cheng KC designed the research study; Cheng KC and Yip ASM performed the research; Yip ASM analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The protocol was approved by the Research Ethics Committee (Kowloon Central/Kowloon East) (Ref: KC/KC-21-0103/ER-1) in accordance with the laws and regulations (including Hong Kong laws), Hospital Authority policy, professional code of conduct, guidance of ICH GCP, and Declaration of Helsinki.
Informed consent statement: This study protocol was reviewed and approved by Hospital Authority Clinical Research Ethics Review Committee, reference number KCC/KEC-2021-0097. Written consent was not required as this is a retrospective study, and all data were retrospective. There was no prospective component to this study (i.e. patients were all anonymized, and there was no prospective follow-up). No patient was contacted for this study. All data were fully anonymized so that they cannot be traced back to an individual in this study.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The datasets generated during and/or analyzed during the current study are not publicly available due to the potential that individual privacy could be compromised, but they are available in an anonymized form from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement–checklist of items, and the manuscript was prepared and revised according to the STROBE Statement–checklist of items.
Corresponding author: Kai-Chi Cheng, FRCS (Ed), Doctor, Department of Surgery, Kwong Wah Hospital, No. 25 Waterloo Road, Kowloon, Hong Kong, China. thomascheng@hotmail.com
Received: October 7, 2021 Peer-review started: October 7, 2021 First decision: December 2, 2021 Revised: December 3, 2021 Accepted: December 23, 2021 Article in press: December 23, 2021 Published online: January 27, 2022 Processing time: 105 Days and 19.8 Hours
Abstract
BACKGROUND
Hepatic resection has become the preferred treatment of choice for colorectal liver metastasis (CLM) patients.
AIM
To identify the prognostic factors and to formulate a new scoring system for management of CLM.
METHODS
Clinicopathologic and long-term survival data were analyzed to identify the significant predictors of survival by univariate and multivariate analyses with the Cox model. A clinical score was constructed based on the analysis results.
RESULTS
Three factors of worse overall survival were identified in the multivariate analysis. They were number of liver metastases ≥ 5, size of the largest liver lesion ≥ 4 cm, and the presence of nodal metastasis from the primary tumor. These three factors were chosen as criteria for a clinical risk score for overall survival. The clinical score highly correlated with median overall survival and 5-year survival (P = 0.002).
CONCLUSION
Priority over surgical resection should be given to the lowest score groups, and alternative oncological treatment should be considered in patients with the highest score.
Core Tip: Using multivariate analysis with the Cox model, we identified three criteria-number of liver metastases ≥ 5, size of the largest liver lesion ≥ 4 cm, and the presence of nodal metastasis from the primary tumor-for a new clinical scoring system. This new clinical score highly correlated with median overall survival and 5-year survival. We propose to use this score to formulate cancer-specific treatment for the patients. Priority over surgical resection should be given to the lowest score groups, and alternative oncological treatment should be considered in patients with the highest score.
