Clinical Score for Predicting Recurrence After Hepatic Resection for Metastatic Colorectal Cancer

作者：Yuman Fong, Joseph G. Fortner, Ruth L. Sun, Murray F. Brennan, Leslie Harold Blumgart · 发表于：Annals of Surgery · 年份：1999 · DOI：10.1097/00000658-199909000-00004 · 被引用次数：3739 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Colorectal Cancer Treatments and Studies、Intraperitoneal and Appendiceal Malignancies

OBJECTIVE: There is a need for clearly defined and widely applicable clinical criteria for the selection of patients who may benefit from hepatic resection for metastatic colorectal cancer. Such criteria would also be useful for stratification of patients in clinical trials for this disease. METHODS: Clinical, pathologic, and outcome data for 1001 consecutive patients undergoing liver resection for metastatic colorectal cancer between July 1985 and October 1998 were examined. These resections included 237 trisegmentectomies, 394 lobectomies, and 370 resections encompassing less than a lobe. The surgical mortality rate was 2.8%. RESULTS: The 5-year survival rate was 37%, and the 10-year survival rate was 22%. Seven factors were found to be significant and independent predictors of poor long-term outcome by multivariate analysis: positive margin (p = 0.004), extrahepatic disease (p = 0.003), node-positive primary (p = 0.02), disease-free interval from primary to metastases <12 months (p = 0.03), number of hepatic tumors >1 (p = 0.0004), largest hepatic tumor >5 cm (p = 0.01), and carcinoembryonic antigen level >200 ng/ml (p = 0.01). When the last five of these criteria were used in a preoperative scoring system, assigning one point for each criterion, the total score was highly predictive of outcome (p < 0.0001). No patient with a score of 5 was a long-term survivor. CONCLUSION: Resection of hepatic colorectal metastases may produce long-term survival and cure. Long-term outcom...