Prognostic factors and evaluation of a clinical score for predicting survival after resection of colorectal liver metastases

Background: Patient outcome after resection of colorectal liver metastases can be predicted by various prognostic factors. Aims: Development of a model for risk stratification based on analysis of prognostic factors. Methods: Data of 201 patients were collected prospectively and included in a single‐centre trial. A total of 20 factors were analysed as to their influence on recurrence‐free and overall survival. Independent prognostic factors were entered into a model of a clinical risk score. Results: Median recurrence‐free survival reached 24 months for all patients; median overall survival was 50 months. Only a synchronous manifestation of primary colorectal carcinoma and liver metastases, the presence of four or more metastases and a carcino‐embryonic antigen level of 200 ng/ml or more significantly influenced recurrence‐free and overall survival in the multivariate analysis. The derived risk stratification grouped the patients according to the following criteria: low risk, zero prognostic factors (n=112); intermediate risk, one factor (n=74); high risk, two or more factors (n=15). The median recurrence‐free survival for low, intermediate and high risk were 30.0, 23.0 and 11.0 months, respectively; the median overall survival was 94.0, 40.0 and 33.0 months. Compared with the low‐risk group, patients with intermediate risk demonstrated an increased hazard ratio (HR) of 1.57‐fold for recurrence (P=0.018) and 1.91‐fold for mortality (P=0.007). For the high‐risk group, the HR rose significantly to 3.26 for recurrence (P<0.0005) and to 3.10 for mortality (P=0.001). Conclusions: The presented clinical score may allow for patients with colorectal liver metastases to be stratified appropriately and for optimization of their subsequent therapeutic management.