External Validation of a Nomogram Predicting Disease-free Survival after Curative Resection of Liver Metastasis from Colorectal Cancer

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  • Okuno Masayuki
    Department of Surgery, Graduate School of Medicine, Kyoto University
  • Hatano Etsuro
    Department of Surgery, Graduate School of Medicine, Kyoto University
  • Nakamura Kojiro
    Department of Surgery, Graduate School of Medicine, Kyoto University
  • Kasai Yosuke
    Department of Surgery, Graduate School of Medicine, Kyoto University
  • Nishio Takahiro
    Department of Surgery, Graduate School of Medicine, Kyoto University
  • Seo Satoru
    Department of Surgery, Graduate School of Medicine, Kyoto University
  • Taura Kojiro
    Department of Surgery, Graduate School of Medicine, Kyoto University
  • Mori Akira
    Department of Surgery, Graduate School of Medicine, Kyoto University
  • Kaido Toshimi
    Department of Surgery, Graduate School of Medicine, Kyoto University
  • Uemoto Shinji
    Department of Surgery, Graduate School of Medicine, Kyoto University

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  • 大腸癌肝転移切除後無病生存の予測ノモグラムの外的妥当性の検証

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Purpose: A nomogram was reported that predicts diseasefree survival (DFS) after hepatic resection for patients with colorectal liver metastasis (CRLM) between 2000 and 2004 at 11 institutions in Japan. We externally validated this nomogram from patients after 2005 at our hospital. Method: Fifty patients with colorectal liver metastasis who had undergone a primary hepatic resection at Kyoto University Hospital from January 2005 to November 2009 were studied. Results: Three year-disease free survival (DFS) rate was 48.0% and the median DFS time was 25.9 months. The nomogram C-index was 0.54. The nomogram score was similar in the recurrent group (n=27) and the non-recurrent group (n=23) (mean 6.96 vs. 5.26, P=0.25). The DFS time of the high risk group (score ≥5) was shorter than that of the low risk group (score ≤4) (19.5 M vs. 51.2 M), but not with statistically significance (P=0.28). Among the 24 patients who received FOLFOX/FOLFIRI as neoadjuvant chemotherapy for liver metastasis, patients were divided into responders (CR+PR) and non-responders (SD+PD). Although the mean nomogram score of each group was similar (7.40 vs. 7.92, P=0.84), the 3-year DFS rate was significantly higher in the responders than the non-responders (70.0% vs. 28.6%, P=0.02). Conclusion: This study suggests that we should be discreet in applying this nomogram to patients receiving perioperative chemotherapy. At present, perioperative chemotherapy with new drugs might affect the disease-free survival after hepatectomy, suggesting that a new nomogram needs to be established.

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