| Objective: Hepatectomy is a potentially curable method for patients with colorectal liver metastases(CRLM).However,the long-term survival after hepatectomy in CRLM patients varies widely in clinical practice.The prognostic risk scores can be used to stratify the risk of CRLM patients after hepatectomy,and select the high-risk patients who are more likely to relapse after hepatectomy.The Fong clinical risk score established in 1999 is a widely used scoring system,however,with the development of modern chemotherapy,the prognostic accuracy and feasibility of the Fong score has been questioned.This study sought to identify the effect of the sizes differences of multiple liver metastases on liver recurrence-free survival(RFS)in patients with colorectal liver metastases(CRLMs)after hepatectomy.Methods: A retrospective analysis was performed on 147 patients with multiple liver metastases from colorectal cancer who underwent hepatectomy with curative intent at the Cancer Hospital of China Medical University.The tumour size ratio(TSR)was defined as the ratio of the maximum diameter of the largest liver lesion to that of the smallest.The entire group was divided into three groups according to the following criteria: group 1,TSR < 2,group 2,2 ≤ TSR < 4,and group 3,TSR ≥ 4.Liver RFS was estimated using the Kaplan-Meier method,and the differences in liver RFS were assessed using the log-rank test.Univariable and multivariable Cox proportional hazard regression models were used to identify independent prognostic factors for liver RFS.The discriminatory power(area under the curve,AUC)of the new model and the Fong clinical score were assessed.Results: A total of 147 patients met the inclusion criteria and were included in the study.In multivariable analysis,the following three factors were independent predictors of poor liver RFS: CEA level ≥ 200 ng / ml(HR = 2.765,95% CI =1.540-4.840,P <0.001),TSR 2-4(HR = 2.580,95% CI = 1.543-4.312,P <0.001)and TSR <2(HR = 4.435,95% CI = 2.499-7.872,P <0.001).In the clinically resectable subgroup,the median survival time of liver RFS in the three groups was 3.8,6.0,and10.7 months,respectively.The differences in liver RFS were statistically significant(log-rank test: group 1 vs group 2,P = 0.002;group 1 vs group 3,P <0.001;group 2vs group 3,P = 0.014).In the multivariate analysis of the above subgroup,TSR(<2,≥2 to <4,and ≥4)remained an independent prognostic factor with strong correlation with liver RFS.As the TSR decreased,the liver RFS gradually worsened.The entire cohort was grouped into three zones according to the Tumor Burden Score(TBS)criteria,and the TSR was able to further stratify patients into different risk groups within each zone,except zone 3(in zone 1,the median liver RFS was 3.2 and 8.9months for group 1 and 2,respectively,P=0.003;in zone 2,the median liver RFS was3.5,5.0 and 10.9 months for group 1,2 and 3,respectively,P<0.05).The two prognostic factors related to liver lesion in the Fong clinical risk score were replaced with the TSR to establish a new prognostic risk model.The discriminatory capacity of the new risk model was superior to that of the Fong clinical score(AUC of 0.659 vs.0.570,respectively).Conclusions: This study was based on patients with multiple liver metastases of colorectal cancer who underwent hepatectomy with curative intent,and proposed a predictive index TSR related to the prognosis of liver RFS.The smaller the TSR,the worse the liver RFS after hepatic resection.TSR can also be used in combination with TBS to predict long-term survival after liver resection in CRLM patients.The TSR prognostic model can be used to evaluate the prognostic effect of the size difference of multiple liver metastases on liver RFS,and its predictive ability is better than the Fong clinical risk score. |
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