Abstract：
BACKGROUND: Accurate prediction of patients at risk for early recurrence (ER) among patients with colorectal liver metastases (CRLM) following preoperative chemotherapy and hepatectomy remains limited.
METHODS: Patients with CRLM who received chemotherapy prior to undergoing curative-intent resection between 2000 and 2020 were identified from an international multi-institutional database. Multivariable Cox regression analysis was used to assess clinicopathological factors associated with ER, and an online calculator was developed and validated.
RESULTS: Among 768 patients undergoing preoperative chemotherapy and curative-intent resection, 128 (16.7 %) patients had ER. Multivariable Cox analysis demonstrated that Eastern Cooperative Oncology Group Performance status ≥1 (HR 2.09, 95%CI 1.46-2.98), rectal cancer (HR 1.95, 95%CI 1.35-2.83), lymph node metastases (HR 2.39, 95%CI 1.60-3.56), mutated Kirsten rat sarcoma oncogene status (HR 1.95, 95%CI 1.25-3.02), increase in tumor burden score during chemotherapy (HR 1.51, 95%CI 1.03-2.24), and bilateral metastases (HR 1.94, 95%CI 1.35-2.79) were independent predictors of ER in the preoperative setting. In the postoperative model, in addition to the aforementioned factors, tumor regression grade was associated with higher hazards of ER (HR 1.91, 95%CI 1.32-2.75), while receipt of adjuvant chemotherapy was associated with lower likelihood of ER (HR 0.44, 95%CI 0.30-0.63). The discriminative accuracy of the preoperative (training: c-index: 0.77, 95%CI 0.72-0.81; internal validation: c-index: 0.79, 95%CI 0.75-0.82) and postoperative (training: c-index: 0.79, 95%CI 0.75-0.83; internal validation: c-index: 0.81, 95%CI 0.77-0.84) models was favorable (https://junkawashima.shinyapps.io/CRLMfollwingchemotherapy/).
CONCLUSIONS: Patient-, tumor- and treatment-related characteristics in the preoperative and postoperative setting were utilized to develop an online, easy-to-use risk calculator for ER following resection of CRLM.
METHODS: Patients with CRLM who received chemotherapy prior to undergoing curative-intent resection between 2000 and 2020 were identified from an international multi-institutional database. Multivariable Cox regression analysis was used to assess clinicopathological factors associated with ER, and an online calculator was developed and validated.
RESULTS: Among 768 patients undergoing preoperative chemotherapy and curative-intent resection, 128 (16.7 %) patients had ER. Multivariable Cox analysis demonstrated that Eastern Cooperative Oncology Group Performance status ≥1 (HR 2.09, 95%CI 1.46-2.98), rectal cancer (HR 1.95, 95%CI 1.35-2.83), lymph node metastases (HR 2.39, 95%CI 1.60-3.56), mutated Kirsten rat sarcoma oncogene status (HR 1.95, 95%CI 1.25-3.02), increase in tumor burden score during chemotherapy (HR 1.51, 95%CI 1.03-2.24), and bilateral metastases (HR 1.94, 95%CI 1.35-2.79) were independent predictors of ER in the preoperative setting. In the postoperative model, in addition to the aforementioned factors, tumor regression grade was associated with higher hazards of ER (HR 1.91, 95%CI 1.32-2.75), while receipt of adjuvant chemotherapy was associated with lower likelihood of ER (HR 0.44, 95%CI 0.30-0.63). The discriminative accuracy of the preoperative (training: c-index: 0.77, 95%CI 0.72-0.81; internal validation: c-index: 0.79, 95%CI 0.75-0.82) and postoperative (training: c-index: 0.79, 95%CI 0.75-0.83; internal validation: c-index: 0.81, 95%CI 0.77-0.84) models was favorable (https://junkawashima.shinyapps.io/CRLMfollwingchemotherapy/).
CONCLUSIONS: Patient-, tumor- and treatment-related characteristics in the preoperative and postoperative setting were utilized to develop an online, easy-to-use risk calculator for ER following resection of CRLM.
摘要：
背景：对术前化疗和肝切除术后结直肠癌肝转移（CRLM）患者早期复发（ER）风险的准确预测仍然有限。
方法：从国际多机构数据库中确定了在2000年至2020年间接受根治性切除术前接受化疗的CRLM患者。多变量Cox回归分析用于评估与ER相关的临床病理因素。并开发并验证了在线计算器。
结果：在接受术前化疗和根治性切除的768例患者中，128例（16.7%）患者有ER。多变量Cox分析表明，东部肿瘤协作组的绩效状态≥1（HR2.09，95CI1.46-2.98），直肠癌（HR1.95，95CI1.35-2.83），淋巴结转移（HR2.39，95CI1.60-3.56），突变的Kirsten大鼠肉瘤癌基因状态（HR1.95，95CI1.25-3.02），化疗期间肿瘤负荷评分增加（HR1.51，95CI1.03-2.24），和双侧转移(HR1.94,95CI1.35-2.79)是术前ER的独立预测因子.在术后模型中，除了上述因素,肿瘤消退等级与较高的ER风险相关（HR1.91，95CI1.32-2.75），而接受辅助化疗与较低的ER可能性相关(HR0.44,95CI0.30-0.63).术前（训练：c指数：0.77，95CI0.72-0.81；内部验证：c指数：0.79，95CI0.75-0.82）和术后（训练：c指数：0.79，95CI0.75-0.83；内部验证：c指数：0.81，95CI0.77-0.84）模型的判别准确性良好（https://junkawashima。shinyapps.io/CRLMfollwingchemistry/)。
结论：患者-，术前和术后的肿瘤和治疗相关特征被用来开发在线，易于使用的风险计算器ER以下CRLM切除。
方法：从国际多机构数据库中确定了在2000年至2020年间接受根治性切除术前接受化疗的CRLM患者。多变量Cox回归分析用于评估与ER相关的临床病理因素。并开发并验证了在线计算器。
结果：在接受术前化疗和根治性切除的768例患者中，128例（16.7%）患者有ER。多变量Cox分析表明，东部肿瘤协作组的绩效状态≥1（HR2.09，95CI1.46-2.98），直肠癌（HR1.95，95CI1.35-2.83），淋巴结转移（HR2.39，95CI1.60-3.56），突变的Kirsten大鼠肉瘤癌基因状态（HR1.95，95CI1.25-3.02），化疗期间肿瘤负荷评分增加（HR1.51，95CI1.03-2.24），和双侧转移(HR1.94,95CI1.35-2.79)是术前ER的独立预测因子.在术后模型中，除了上述因素,肿瘤消退等级与较高的ER风险相关（HR1.91，95CI1.32-2.75），而接受辅助化疗与较低的ER可能性相关(HR0.44,95CI0.30-0.63).术前（训练：c指数：0.77，95CI0.72-0.81；内部验证：c指数：0.79，95CI0.75-0.82）和术后（训练：c指数：0.79，95CI0.75-0.83；内部验证：c指数：0.81，95CI0.77-0.84）模型的判别准确性良好（https://junkawashima。shinyapps.io/CRLMfollwingchemistry/)。
结论：患者-，术前和术后的肿瘤和治疗相关特征被用来开发在线，易于使用的风险计算器ER以下CRLM切除。
