scholarly journals Proposal of Two Prognostic Models for the Prediction of 10-Year Survival after Liver Resection for Colorectal Metastases

HPB Surgery ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Ulf Kulik ◽  
Mareike Plohmann-Meyer ◽  
Jill Gwiasda ◽  
Joline Kolb ◽  
Daniel Meyer ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
External Validation ◽  
Prognostic Models ◽  
Colorectal Metastases ◽  
Receiver Operating Curve ◽  
Resection Margins ◽  
Patient Counselling ◽  
Receiver Operating

Background. One-third of 5-year survivors after liver resection for colorectal liver metastases (CLM) develop recurrence or tumor-related death. Therefore 10-year survival appears more adequate in defining permanent cure. The aim of this study was to develop prognostic models for the prediction of 10-year survival after liver resection for colorectal liver metastases. Methods. N=965 cases of liver resection for CLM were retrospectively analyzed using univariable and multivariable regression analyses. Receiver operating curve analyses were used to assess the sensitivity and specificity of developed prognostic models and their potential clinical usefulness. Results. The 10-year survival rate was 15.2%. Age at liver resection, application of chemotherapies of the primary tumor, preoperative Quick’s value, hemoglobin level, and grading of the primary colorectal tumor were independent significant predictors for 10-year patient survival. The generated formula to predict 10-year survival based on these preoperative factors displayed an area under the receiver operating curve (AUROC) of 0.716. In regard to perioperative variables, the distance of resection margins and performance of right segmental liver resection were additional independent predictors for 10-year survival. The logit link formula generated with pre- and perioperative variables showed an AUROC of 0.761. Conclusion. Both prognostic models are potentially clinically useful (AUROCs >0.700) for the prediction of 10-year survival. External validation is required prior to the introduction of these models in clinical patient counselling.

scholarly journals Prognostic Factors after Liver Resection for Colorectal Liver Metastasis

2015 ◽  
Vol 28 (3) ◽  
pp. 357 ◽  
Author(s):  
Margarida Matias ◽  
Mafalda Casa-Nova ◽  
Mariana Faria ◽  
Ricardo Pires ◽  
Joana Tato-Costa ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Liver Resection ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Regional Lymph Node ◽  
Scoring Systems ◽  
Cox Proportional Hazards Model ◽  
Prognostic Scores ◽  
Prognostic Models

<p><strong>Introduction:</strong> Surgery is the only potentially curative treatment for patients with colorectal liver metastases, resulting in 5-year survival rates of 36–58%. Although many studies have been performed to determine prognostic factors for tumor recurrence and survival after resection of colorectal liver metastases, there are few prognostic scoring systems stratifying patients undergoing surgery for colorectal liver metastases into risk group models.<br /><strong>Objectives:</strong> To identify, evaluate and compare the existing prognostic scores for survival after surgery for resection of colorectal liver metastases.<br /><strong>Material and Methods:</strong> Electronic search in PubMed, Cochrane and Embase from 1990 to 2013 using the terms ‘hepatic resection’, ‘colorectal cancer’, ‘liver metastasis’, ‘hepatectomy’, ‘prognostic’, and ‘score‘. Only studies proposing a prognostic model or risk stratification based on clinical and/or pathological variables were included.<br /><strong>Results:</strong> From 1996 to June 2013, 19 scoring systems were identified, including one nomogram. Thirty prognostic factors were identified although none of the factors was common to all prognostic models. The 4 factors most often included were: number of liver metastases, regional lymph node metastization of primary tumor, preoperative CEA level and maximum size of metastases. The median study sample size was 305 patients (81-1 568 patients) and median follow-up was 33 months (16-54 months). All studies were retrospective and used the Cox proportional hazards model for multi-variable analysis.<br /><strong>Conclusion:</strong> Several factors have been constantly reported as having prognostic value after liver resection of colorectal liver<br />metastases, although there is no consensus on the ideal scoring system.</p>

scholarly journals Influence of the Type and Amount of Liver Resection on the Survival of the Patients with Colorectal Metastases

2018 ◽  
Vol 6 (6) ◽  
pp. 1046-1051
Author(s):  
Stefan Petrovski ◽  
Marija Karakolevska-Ilova ◽  
Elena Simeonovska-Joveva ◽  
Aleksandar Serafimov ◽  
Ljubica Adzi-Andov ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Poor Prognosis ◽  
Colorectal Liver Metastases ◽  
Patient Survival ◽  
Radical Resection ◽  
Colorectal Metastases ◽  
Specific Technique ◽  
Left Hemihepatectomy ◽  
The Impact

INTRODUCTION: Colorectal liver metastases have a poor prognosis, and only 2% have an average 5-year survival if left untreated. Despite radical resection, the average five-year survival is between 25% and 44%.AIM: To explore the experience of the Clinic in the treatment of colorectal liver metastases, comparing it with data from the literature and based on the comparison to determine the influence of the type and extensity of resection survival after radical surgical treatment of patients.METHODS: This is a retrospective study. The study comprised the period between 01.01.2006 to 31.12.2015. It included a total of 239 cases, of whom: 179 patients underwent radical interventions, 5 palliative and 55 patients underwent explorative interventions due to liver metastases.RESULTS: Radical resection of liver metastases has the impact of the patient survival, and the survival is the smallest in the patients with left hemihepatectomy and the longest in the patients with bisegmentectomy. But no specific technique and the number of resected segments influenced the survival of patients with colorectal liver metastases.CONCLUSION: In patients with colorectal liver metastases only resection has potentially curative character. The type and amount of liver resection has no influence of the survival.

scholarly journals Treatment of colorectal liver metastases with a combination of liver resection and radiofrequency ablation

2005 ◽  
Vol 58 (1-2) ◽  
pp. 57-62
Author(s):  
Dragan Radovanovic ◽  
Dejan Stevanovic ◽  
Berislav Vekic ◽  
Dragos Stojanovic ◽  
Ivan Pavlovic
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Invasive Procedure ◽  
Colon Resection ◽  
Colorectal Metastases ◽  
Colorectal Cancers ◽  
Study Group ◽  
Hepatic Tumors

Introduction. Radiofrequency ablation is a new invasive procedure that is being increasingly used in the treatment of colorectal liver metastases. Resection as the only potential cure for colorectal liver metastases is limited by the size and the itrahepatic localization of lesions. Radiofrequency ablation may extend the limitations of classic surgery. In this work we analyzed the combination of surgical liver resection and radiofrequency ablation of liver metastases. Material and methods. This study included 11 patients with colorectal metastases. Colon resection and radiofrequency ablation have been performed in five (5) patients, three (3) patients underwent liver resection and radiofrequency ablation, and in three (3) patients colon resection, liver resection and radiofrequency ablation were performed. Results. In our study group, there were 6 (54.54%) men and 5 (45.45%) women aged 55 to 66 years and 52 to 67 years of age, respectively. During operations, we treated 30 liver metastases, 2.72 metastases per patient. There were from 2 to 4 ablation metastases. The diameter of colorectal metastases was between 11 mm and 44 mm. Most of ablation metastases (12 or 40%) were between 2.1 cm and 3 cm in diameter. Only 10% of ablation metastases were over 40 mm in diameter. Discussion. The majority of patients with metastatic colorectal hepatic tumors are not candidates for surgical resection, due to tumor size, location and multifocality. However, we can treat advanced colorectal cancers and colorectal liver metastases with a combination of liver resection and radiofreqency ablation. In this way we can operate and give a chance to patients with multifocal metastases and metastases with a diametar over 40 mm. Conclusion A combination of liver resection and radiofreqency ablation in treatment of advanced colorectal cancers with liver metastases is a good treatment modality which increases the number of operable cases.

Is chemotherapy failure a contraindication for liver resection in liver metastases of colorectal cancer? A multivariate analysis

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4066-4066
Author(s):  
U. P. Neumann ◽  
A. Thelen ◽  
S. Jonas ◽  
H. Riess ◽  
P. Neuhaus
Keyword(s):  
Multivariate Analysis ◽  
Liver Resection ◽  
Liver Metastases ◽  
Vascular Invasion ◽  
Colorectal Liver Metastases ◽  
Colorectal Metastases ◽  
Term Survival ◽  
Long Term Survival ◽  
Poor Outcome

4066 Background: Liver resection is the only curative treatment offering a chance of long-term survival in patients with colorectal liver metastases. Chemotherapy is increasingly proposed as neoadjuvant treatment in patients with irresectable liver metastases. However, a large number of patients show progress while on chemotherapy. Recent data indicated that liver resection in patients receiving chemotherapy with tumor progress is associated with poor outcome. The aim of the study was to identify risk factors for poor outcome in patients with preoperative chemotherapy with resectable colorectal liver metastases (CRM). Methods: We retrospectively analyzed the outcome of 168 consecutive patients who underwent liver resection for CRM after systemic chemotherapy between 1995 and 2004. Overall, 132 (78.6%) patients had first line, 24 (14.3%) patients second line and 12 (7.2%) third or fourth line chemotherapy. Three groups of patients were identified according to the chemotherapy response. 48 patients (28.6%) had a tumor response (group 1), in 20 (11.9%) the condition stabilized (group 2), and 100 (59.5%) patients had tumor progression (group 3). Median follow-up was 1.8 yrs (range (6 days - 9.5 yrs). Results: Demographic data, size of largest node, number of nodes, extent of resection and postoperative course were equally distributed between groups. Overall, survival was 89%, 56%, and 31% at 1, 3, and 5 years, respectively. Five-year survival was similar between groups. In the univariate analysis, only incomplete resection and vascular invasion were associated with poor outcome. In the multivariate analysis, only vascular invasion was significantly associated with fatal outcome. Neither the number of lines nor the chemotherapeutic agent was associated with decreased survival. Conclusions: In a large patient population, liver resection offered long-term survival for patients with multiple colorectal metastases, even in cases with tumor growth whilst receiving chemotherapy. This underlines that, whenever a curative resection is possible, surgical resection of liver metastases is justified even in patients with therapy failure due to chemotherapy. No significant financial relationships to disclose.

Radiofrequency ablation of colorectal liver metastases

2019 ◽  
Vol 98 (10) ◽  
Keyword(s):  
Radiofrequency Ablation ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Postoperative Mortality ◽  
Disease Free Survival ◽  
Female Ratio ◽  
Liver Resections ◽  
Multi Stage

Introduction: Radical liver resection is the only method for the treatment of patients with colorectal liver metastases (CLM); however, only 20–30% of patients with CLMs can be radically treated. Radiofrequency ablation (RFA) is one of the possible methods of palliative treatment in such patients. Methods: RFA was performed in 381 patients with CLMs between 01 Jan 2001 and 31 Dec 2018. The mean age of the patients was 65.2±8.7 years. The male to female ratio was 2:1. Open laparotomy was done in 238 (62.5%) patients and the CT-navigated transcutaneous approach was used in 143 (37.5%) patients. CLMs <5 cm (usually <3 cm) in diameter were the indication for RFA. We used RFA as the only method in 334 (87.6%) patients; RFA in combination with resection was used in 36 (9.4%), and with multi-stage resection in 11 (3%) patients. We performed RFA in a solitary CLM in 170 (44.6%) patients, and in 2−5 CLMs in 211 (55.6%) patients. We performed computed tomography in each patient 48 hours after procedure. Results: The 30-day postoperative mortality was zero. Complications were present in 4.8% of transcutaneous and in 14.2% of open procedures, respectively, in the 30-day postoperative period. One-, 3-, 5- and 10-year overall survival rates were 94.8, 66.8, 43.9 and 16.6%, respectively, in patients undergoing RFA, and 90.6, 69.1, 52.8 and 39.2%, respectively, in patients with liver resections. Disease free survival was 63.2, 30.1, 18.4 and 13.1%, respectively, in the same patients after RFA, and 71.1, 33.3, 22.8 and 15.5%, respectively, after liver resections. Conclusion: RFA is a palliative thermal ablation method, which is one of therapeutic options in patients with radically non-resectable CLMs. RFA is useful especially in a non-resectable, or resectable (but for the price of large liver resection) solitary CLM <3 cm in diameter and in CLM relapses. RFA is also part of multi-stage liver procedures.

Impact of Visceral Adiposity as Well as Sarcopenic Factors on Outcomes in Patients Undergoing Liver Resection for Colorectal Liver Metastases

2017 ◽  
Vol 42 (4) ◽  
pp. 1180-1191 ◽  
Author(s):  
Atsushi Kobayashi ◽  
Toshimi Kaido ◽  
Yuhei Hamaguchi ◽  
Shinya Okumura ◽  
Hisaya Shirai ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Visceral Adiposity

scholarly journals Liver resection for concomitant colorectal liver metastases and intrahepatic cholangiocarcinoma: a rare combination

2009 ◽  
Vol 24 (11) ◽  
pp. 1349-1349
Author(s):  
Georgios C. Sotiropoulos ◽  
Evangelos Tagkalos ◽  
Andreas Kreft ◽  
Vasiliy Moskalenko ◽  
Ursula Gönner ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Metastases ◽  
Intrahepatic Cholangiocarcinoma ◽  
Colorectal Liver Metastases ◽  
Rare Combination

scholarly journals SURG-02. SURVIVAL PREDICTION AFTER NEUROSURGICAL RESECTION OF BRAIN METASTASES: A MACHINE LEARNING APPROACH

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii203-ii203
Author(s):  
Alexander Hulsbergen ◽  
Yu Tung Lo ◽  
Vasileios Kavouridis ◽  
John Phillips ◽  
Timothy Smith ◽  
...  
Keyword(s):  
Machine Learning ◽  
Brain Metastases ◽  
External Validation ◽  
Superior Performance ◽  
Prognostic Models ◽  
Receiver Operating Curve ◽  
Gradient Boosting ◽  
Survival Prediction ◽  
Ensemble Model ◽  
Adaptive Boosting

Abstract INTRODUCTION Survival prediction in brain metastases (BMs) remains challenging. Current prognostic models have been created and validated almost completely with data from patients receiving radiotherapy only, leaving uncertainty about surgical patients. Therefore, the aim of this study was to build and validate a model predicting 6-month survival after BM resection using different machine learning (ML) algorithms. METHODS An institutional database of 1062 patients who underwent resection for BM was split into a 80:20 training and testing set. Seven different ML algorithms were trained and assessed for performance. Moreover, an ensemble model was created incorporating random forest, adaptive boosting, gradient boosting, and logistic regression algorithms. Five-fold cross validation was used for hyperparameter tuning. Model performance was assessed using area under the receiver-operating curve (AUC) and calibration and was compared against the diagnosis-specific graded prognostic assessment (ds-GPA); the most established prognostic model in BMs. RESULTS The ensemble model showed superior performance with an AUC of 0.81 in the hold-out test set, a calibration slope of 1.14, and a calibration intercept of -0.08, outperforming the ds-GPA (AUC 0.68). Patients were stratified into high-, medium- and low-risk groups for death at 6 months; these strata strongly predicted both 6-months and longitudinal overall survival (p &lt; 0.001). CONCLUSIONS We developed and internally validated an ensemble ML model that accurately predicts 6-month survival after neurosurgical resection for BM, outperforms the most established model in the literature, and allows for meaningful risk stratification. Future efforts should focus on external validation of our model.

Sign in / Sign up

Export Citation Format

Share Document