Limits...
Adjuvant therapy after resection of colorectal liver metastases: the predictive value of the MSKCC clinical risk score in the era of modern chemotherapy.

Rahbari NN, Reissfelder C, Schulze-Bergkamen H, Jäger D, Büchler MW, Weitz J, Koch M - BMC Cancer (2014)

Bottom Line: A total of 137 (43%) patients had a MSKCC-CRS > 2.It improved survival markedly in high-risk patients with a MSKCC-CRS > 2 (HR 0.40; 95% CI 0.23-0.69), whereas it was of no benefit in patients with a MSKCC-CRS ≤ 2 (HR 0.90; 95% CI 0.57-1.43).Validation in independent patient cohorts is required.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. nuh.rahbari@uniklinikum-dresden.de.

ABSTRACT

Background: Despite introduction of effective chemotherapy protocols, it has remained uncertain, if patients with colorectal cancer (CRC) liver metastases should receive adjuvant therapy. Clinical or molecular predictors may help to select patients at high risk for disease recurrence and death who obtain a survival advantage by adjuvant chemotherapy.

Methods: A total of 297 patients with potentially curative resection of CRC liver metastases were analyzed. These patients had no neoadjuvant therapy, no extrahepatic disease and negative resection margins. The primary endpoint was overall survival. Patients' risk status was evaluated using the Memorial Sloan-Kettering Cancer Center clinical risk score (MSKCC-CRS). Multivariable analyses were performed using Cox proportional hazard models.

Results: A total of 137 (43%) patients had a MSKCC-CRS > 2. Adjuvant chemotherapy was administered to 116 (37%) patients. Patients who received adjuvant chemotherapy were of younger age (p = 0.03) with no significant difference in the presence of multiple metastases (p = 0.72) or bilobar metastases (p = 0.08). On multivariate analysis adjuvant chemotherapy was associated with improved survival in the entire cohort (Hazard ratio 0.69; 95% confidence interval 0.69-0.98). It improved survival markedly in high-risk patients with a MSKCC-CRS > 2 (HR 0.40; 95% CI 0.23-0.69), whereas it was of no benefit in patients with a MSKCC-CRS ≤ 2 (HR 0.90; 95% CI 0.57-1.43).

Conclusions: The MSKCC-CRS offers a tool to select patients for adjuvant therapy after resection of CRC liver metastases. Validation in independent patient cohorts is required.

Show MeSH

Related in: MedlinePlus

Influence of adjuvant chemotherapy on overall survival after potentially curative resection of colorectal liver metastases in patients with a borderline risk status. A. Overall survival of patients with a MSKCC-CRS 2 stratified for the type of adjuvant therapy (p = 0.62). B. Overall survival of patients with a MSKCC-CRS 3 stratified for the type of adjuvant therapy (p = 0.01). Data are presented as Cox proportional hazards.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4008001&req=5

Figure 2: Influence of adjuvant chemotherapy on overall survival after potentially curative resection of colorectal liver metastases in patients with a borderline risk status. A. Overall survival of patients with a MSKCC-CRS 2 stratified for the type of adjuvant therapy (p = 0.62). B. Overall survival of patients with a MSKCC-CRS 3 stratified for the type of adjuvant therapy (p = 0.01). Data are presented as Cox proportional hazards.

Mentions: We performed subgroup analyses to further elucidate the efficacy of adjuvant chemotherapy in patients with a borderline risk status and to assess the adequacy of the applied cut-off for the MSKCC-CRS (≤ 2 vs. > 2) to stratify patients in a low-and high-risk group. These analyses revealed that adjuvant chemotherapy failed to improve survival in patients with a MSKCC-CRS of 2, whereas it was associated with a significant survival benefit in patients with a MSKCC-CRS of 3 (Figure 2).


Adjuvant therapy after resection of colorectal liver metastases: the predictive value of the MSKCC clinical risk score in the era of modern chemotherapy.

Rahbari NN, Reissfelder C, Schulze-Bergkamen H, Jäger D, Büchler MW, Weitz J, Koch M - BMC Cancer (2014)

Influence of adjuvant chemotherapy on overall survival after potentially curative resection of colorectal liver metastases in patients with a borderline risk status. A. Overall survival of patients with a MSKCC-CRS 2 stratified for the type of adjuvant therapy (p = 0.62). B. Overall survival of patients with a MSKCC-CRS 3 stratified for the type of adjuvant therapy (p = 0.01). Data are presented as Cox proportional hazards.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4008001&req=5

Figure 2: Influence of adjuvant chemotherapy on overall survival after potentially curative resection of colorectal liver metastases in patients with a borderline risk status. A. Overall survival of patients with a MSKCC-CRS 2 stratified for the type of adjuvant therapy (p = 0.62). B. Overall survival of patients with a MSKCC-CRS 3 stratified for the type of adjuvant therapy (p = 0.01). Data are presented as Cox proportional hazards.
Mentions: We performed subgroup analyses to further elucidate the efficacy of adjuvant chemotherapy in patients with a borderline risk status and to assess the adequacy of the applied cut-off for the MSKCC-CRS (≤ 2 vs. > 2) to stratify patients in a low-and high-risk group. These analyses revealed that adjuvant chemotherapy failed to improve survival in patients with a MSKCC-CRS of 2, whereas it was associated with a significant survival benefit in patients with a MSKCC-CRS of 3 (Figure 2).

Bottom Line: A total of 137 (43%) patients had a MSKCC-CRS > 2.It improved survival markedly in high-risk patients with a MSKCC-CRS > 2 (HR 0.40; 95% CI 0.23-0.69), whereas it was of no benefit in patients with a MSKCC-CRS ≤ 2 (HR 0.90; 95% CI 0.57-1.43).Validation in independent patient cohorts is required.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. nuh.rahbari@uniklinikum-dresden.de.

ABSTRACT

Background: Despite introduction of effective chemotherapy protocols, it has remained uncertain, if patients with colorectal cancer (CRC) liver metastases should receive adjuvant therapy. Clinical or molecular predictors may help to select patients at high risk for disease recurrence and death who obtain a survival advantage by adjuvant chemotherapy.

Methods: A total of 297 patients with potentially curative resection of CRC liver metastases were analyzed. These patients had no neoadjuvant therapy, no extrahepatic disease and negative resection margins. The primary endpoint was overall survival. Patients' risk status was evaluated using the Memorial Sloan-Kettering Cancer Center clinical risk score (MSKCC-CRS). Multivariable analyses were performed using Cox proportional hazard models.

Results: A total of 137 (43%) patients had a MSKCC-CRS > 2. Adjuvant chemotherapy was administered to 116 (37%) patients. Patients who received adjuvant chemotherapy were of younger age (p = 0.03) with no significant difference in the presence of multiple metastases (p = 0.72) or bilobar metastases (p = 0.08). On multivariate analysis adjuvant chemotherapy was associated with improved survival in the entire cohort (Hazard ratio 0.69; 95% confidence interval 0.69-0.98). It improved survival markedly in high-risk patients with a MSKCC-CRS > 2 (HR 0.40; 95% CI 0.23-0.69), whereas it was of no benefit in patients with a MSKCC-CRS ≤ 2 (HR 0.90; 95% CI 0.57-1.43).

Conclusions: The MSKCC-CRS offers a tool to select patients for adjuvant therapy after resection of CRC liver metastases. Validation in independent patient cohorts is required.

Show MeSH
Related in: MedlinePlus