Imai et al reported a nomogram for evaluating a patient with colorectal cancer metastatic to the liver that is initially unresectable. This can help to identify a patient who may benefit from more aggressive management. The authors are from HopitalUniversitaire Paul Brousse, INSERM (Villejuif), Kumamoto University, and Universite Paris-Sud.
Patient selection: metastatic colorectal cancer in the liver, initially unresectable but later resectable after therapy
Parameters:
(1) N status of primary tumor
(2) number of liver metastases at hepatectomy
(3) serum CA19-9 concentration in U/mL at time of hepatectomy
(4) response to first-line chemotherapy
(5) concomitant extrahepatic disease
|
Parameter
|
Finding
|
Points
|
|
N status
|
N0
|
0
|
|
|
N1 or N2
|
5
|
|
number of liver metastases
|
1 to 6
|
0
|
|
|
>= 7
|
7
|
|
CA19-9
|
<= 37 U/mL
|
0
|
|
|
> 37 U/mL
|
10
|
|
response to chemotherapy
|
response
|
0
|
|
|
stabilization
|
0
|
|
|
progression
|
9
|
|
extrahepatic disease
|
no
|
0
|
|
|
yes
|
4
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 35
• The higher the score the worse the survival after hepatectomy.
• A score > 16 was associated with a worse survival.
probability of 3-year overall survival after hepatectomy =
= (0.0000244624 * ((score)^3)) - (0.00131844 * ((score)^2)) - (0.0071308 * (score)) + 0.814452
Performance:
• The area under the ROC curve is 0.66.
