Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Konkret geht es um den Diabetes-Patienten mit kardiovaskulären Erkrankungen oder Risiken, die Herzinsuffizienz sowie die kardiovaskuläre Primär- und Sekundärprävention. Sind Sie hier schon auf dem neuesten Stand? Unsere Experten beleuchten, wo und warum das bisherige Procedere geändert werden soll und was in der Praxis sinnvoll ist. Holen Sie sich Ihr Update und 2 CME-Punkte beim MMW-Webinar am 24. April von 17.30 bis 19 Uhr. 
Erweiterte Suche
Anmelden
nach oben
Annals of Surgical Oncology
Erschienen in: Annals of Surgical Oncology 10/2011

Open Access 01.10.2011 | Hepatobiliary Tumors

Is the Clinical Risk Score for Patients with Colorectal Liver Metastases Still Useable in the Era of Effective Neoadjuvant Chemotherapy?

verfasst von: Ninos Ayez, MD, Zarina S. Lalmahomed, MD, Anne E. M. van der Pool, MD, Yvonne Vergouwe, PhD, Kees van Montfort, PhD, Jeroen de Jonge, MD, PhD, Alexander M. M. Eggermont, MD, PhD, Jan N. M. IJzermans, MD, PhD, Cornelis Verhoef, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 10/2011

insite
INHALT
download
DOWNLOAD
print
DRUCKEN
insite
SUCHEN

Abstract

Background

Several clinical risk scores (CRSs) for the outcome of patients with colorectal liver metastases have been validated, but not in patients undergoing neoadjuvant chemotherapy. Therefore, this study evaluates the predictive value of these CRSs in this specific group.

Methods

Between January 2000 and December 2008, all patients undergoing a metastasectomy were analyzed and divided into two groups: 193 patients did not receive neoadjuvant chemotherapy (group A), and 159 patients received neoadjuvant chemotherapy (group B). In group B, the CRSs were calculated before and after administration of neoadjuvant chemotherapy. Results were evaluated by using the CRSs proposed by Nordlinger et al., Fong et al., Nagashima et al., and Konopke et al.

Results

In groups A and B, the overall median survival was 43 and 47 months, respectively (P = 0.648). In group A, all CRSs used were of statistically significant predictive value. Before administration of neoadjuvant chemotherapy, only the Nordlinger score was of predictive value. After administration of neoadjuvant chemotherapy, all CRSs were of predictive value again, except for the Konopke score.

Conclusions

Traditional CRSs are not a reliable prognostic tool when used in patients before treatment with neoadjuvant chemotherapy. However, CRSs assessed after the administration of neoadjuvant chemotherapy are useful to predict prognosis.
In patients with colorectal cancer, about 50–60% will develop metastatic disease. Synchronous metastases are present in 25% of colorectal cancer patients.1,2 Nowadays, neoadjuvant chemotherapy is increasingly used for patients with colorectal liver metastases (CRLM). New systemic regimes are highly effective, and response rates of 50–80% have been reported; they appear to convert 10–30% of the formerly irresectable CRLM to a resectable size.3‐6 Several clinical risk scores (CRSs) for the outcome of patients with CRLM have been published.7‐16 A CRS is a predictive tool for patients with CRLM who undergo resection.4,8‐12,17‐22 CRSs were initially used to predict the prognosis of patients with CRLM considered for surgery. In addition, CRSs are used to stratify patients into risk categories, to compare patient cohorts from different studies and institutions, and to select patients for different treatment protocols.
However, the predictive value of these CRSs has not been assessed in the specific group of patients receiving neoadjuvant chemotherapy before resection of CRLM. It is possible that the traditional CRSs, applied before administration of neoadjuvant chemotherapy, may no longer be capable of correctly predicting the outcome in patients receiving neoadjuvant chemotherapy.4,19,20
Therefore, in the present study, four widely used CRSs are applied in a cohort of patients with CRLM who received neoadjuvant chemotherapy before resection, to evaluate whether neoadjuvant chemotherapy influences the predictive value of CRSs.

Patients and Methods

Between January 2000 and December 2008, all consecutive patients who underwent liver resection for CRLM were analyzed. Patient characteristics were collected retrospectively from a prospectively recorded database. Two groups were created: group A (patients without neoadjuvant chemotherapy; n = 193) and group B (patients with neoadjuvant chemotherapy; n = 159). In group B, the CRSs were calculated before (B1) and after (B2) administration of neoadjuvant chemotherapy.
The prospective database comprises data on age, gender, primary tumor site, pathological primary tumor and lymph node stage, time between detection of primary tumor and liver metastases, type of surgery, location, maximum number and size of liver metastases on computed tomographic scan and pathology, carcinoembryonic antigen (CEA) levels, radicality of surgical margin, and extrahepatic disease.
Ours is a referral hospital; perioperative chemotherapy is not administered as a standard treatment protocol for patients with CRLM. Most of our patients have already received neoadjuvant chemotherapy in the referring hospital. In our center, the indication for neoadjuvant chemotherapy is twofold: in case of initially difficult/unresectable liver metastases, or in case of multiple synchronous metastases numbering ≥4. It is our policy not to resect in case of tumor progression during chemotherapy. Neoadjuvant chemotherapy protocols comprise oxaliplatin-based combination therapies with or without bevacizumab. None of the patients in the present study received adjuvant chemotherapy. The duration of the chemotherapy was at minimum 3 cycles. If there were resectable metastases, chemotherapy was given to a maximum of 6 cycles or was stopped after 3 cycles in case of disappearing metastases. In case of unresectable disease, chemotherapy was provided until resectable status was achieved.

CRSs

Four widely used CRSs were evaluated (Table 1).8,9,11,12 The Nordlinger score includes seven risk factors and defines three risk groups, but, as proposed by Nordlinger et al., we used only six risk factors. Fong’s score includes five risk factors and defines two risk groups. Nagashima’s score includes five risk factors and defines three risk groups. The Konopke score includes three risk factors and defines three risk groups. These four CRSs were applied on our data to evaluate each of the scores.
Table 1
Clinical risk score
Scale
Clinical score criteriaa
Criteria
Score
Nordlinger
1. Age ≥60 years
2. Extension into the serosa of the primary cancer
3. Lymphatic spread of the primary cancer
4. Interval less than 2 years from primary tumor to metastases
5. Number of metastases ≥4
6. Largest size of liver metastasis ≥5
Exclusion criteria
1. Incomplete liver tumor resection
2. Extrahepatic tumor involvement
• 0–2 risk factors “low risk”
• 3–4 risk factors “intermediate risk”
• 5–6 risk factors “high risk”
Fong
1. Number of liver metastases >1
2. Preoperative CEA level >200 ng/ml
3. Largest size of liver metastasis ≥5
4. Lymph node–positive primary tumor
5. Interval from primary tumor resection to diagnosis of the liver metastases <12 months
Exclusion criteria
1. Positive resection margin
2. Preoperative extrahepatic disease
• 0–2 risk factors
• 3–4–5 risk factors
Nagashima
1. Serosal invasion of primary tumor
2. Positive lymph node of primary tumor
3. Number of hepatic metastases ≥2
4. Diameter of hepatic metastases ≥5 cm
5. Resectable extrahepatic metastases.
Inclusion criteria
1. Expected radical excision (including extrahepatic metastases)
• 0–1 grade 1
• 2–3 grade 2
• ≥4 grade 3
Konopke
1. Number of liver metastases ≥4
2. CEA level (ng/ml) ≥200
3. Synchronous liver metastases
Exclusion criteria
1. Recurrent liver metastases
2. Simultaneous extrahepatic tumor recurrence
3. Simultaneous local ablative therapy
4. Intraoperative dissemination of tumor cells
5. Macroscopically or microscopically incomplete resection
• 0 low risk
• 1 intermediate risk
• ≥2 high risk
CEA carcinoembryonic antigen
aEach criterion is assigned 1 point

Outcome

Overall survival (OS) was defined as the interval (in months) between resection of CRLM and death, or the date of last follow-up. Disease-free survival (DFS) was defined as the interval (in months) between resection of CRLM and intra- and/or extrahepatic recurrence, death without recurrence, or date of last follow-up without recurrence.

Statistical Analysis

Descriptive statistics are expressed as median (range). Comparison between the categorical variables was made with the chi-square test. Pre- and postchemotherapy variables are expressed as mean ± standard deviation (SD) and compared with the paired t-test. Survival analysis was performed by the Kaplan-Meier method. Comparison between survival curves was made with log rank tests. For missing values, multiple imputation was used.
SPSS software, version 17.0 (SPSS, Chicago, IL), was used for statistical analysis; a P-value of ≤0.05 is considered statistically significant.

Results

Between January 2000 and December 2008, a total of 352 patients underwent liver resection for CRLM (Table 2). The median follow-up was 32 (range 0–121) months. Median age was 63 (range 30–86) years. The clinical characteristics are presented in Table 2. The median DFS was 11 (95% confidence interval [CI] 9–13) months, and the median OS was 46 (95% CI 39–53) months. Neoadjuvant chemotherapy was provided to 159 patients (45.2%). Chemotherapy was given in a median of 6 (1–15) courses. In total, 43 patients received more than 6 courses with a median of 9 (7–15) courses.
Table 2
Characteristics of the study patients
Characteristic
All patients (n = 352)
Patients without chemotherapy (group A) (n = 193)
Patients with chemotherapy (group B) (n = 159)
Value
% or range
Value
% or range
Value
% or range
Male
218
62
122
63
96
60
Median age (years)
63
30–86
64
30–86
62
36–84
Primary tumor
 Rectal cancer
167
47
90
47
77
48
 T3
259
74
140
73
119
75
 T4
30
9
15
8
15
9
 Missing before imputation
6
2
    
 Positive lymph node
205
58
110
57
92
58
 Missing before imputation
6
2
    
Liver metastases
 Synchronous
172
49
55
29
117
74
 Median diameter (cm)
3.5
0.5–18
3.5
0.9–15
3.4
0.5–18
 Missing before imputation
5
1
    
 Median no. of metastases
2
1–10
1
1–8
3.0
1–10
 Missing before imputation
2
1
    
 Bilobar
135
38
52
27
83
52
 Extrahepatic
29
8
7
44
22
14
 Incomplete resection
72
21
40
21
32
20
 Missing before imputation
7
2
    
 Overall survival (months)
46
95% CI 39–53
43
95% CI 34–52
47
95% CI 33–61
 Disease-free survival (monthos)
11
95% CI 9–13
14
95% CI 11–17
9
95% CI 7–11
CI confidence interval

Pre- and Postchemotherapy

In patients receiving neoadjuvant chemotherapy, the variables size of metastases, CEA level, number of metastases, bilobar disease, and extrahepatic disease were analyzed before and after administration of neoadjuvant chemotherapy. Before neoadjuvant chemotherapy, the mean ± SD size, CEA level, and number of metastases were 3.98 ± 2.62 cm, 171 ± 568 μg/l and 3.19 ± 1.95, respectively. Before neoadjuvant chemotherapy, 83 patients had bilobar disease and 22 had extrahepatic disease. After neoadjuvant chemotherapy, the mean ± SD size, CEA level, and number of metastases were 2.83 ± 2.45 cm, 21 ± 48 μg/l and 2.64 ± 1.96, respectively. After chemotherapy, 81 patients had bilobar disease and 22 patients still had extrahepatic disease. To determine the size of the metastases the postchemotherapy abdominal scans were assessed. To determine the number of metastases the postsurgery pathological report was examined. Only when complete response was reported did the number of metastases decrease. The difference between pre- and postneoadjuvant chemotherapy was significant for the size of metastases, CEA level, and the number of metastases (P < 0.001, P = 0.001, and P < 0.001, respectively). No significant difference was found between bilobar disease and extrahepatic disease before and after neoadjuvant chemotherapy (P = 0.832 and P = 0.999, respectively).

Nordlinger

The CRS of Nordlinger could be applied to 150 patients in group A and to 101 patients in group B (Table 1).
In group A the median DFS was 16 (95% CI 12–20) months, and the median OS was 48 (95% CI 33–63) months (Tables 3, 4). In group A, the Nordlinger score was of statistically significant predictive value. There was a significant difference between the CRS subgroups for DFS and OS (P = 0.028 and P = 0.006, respectively). Because of the small numbers of patients, the CRS subgroup 3 (CRS 5–6) was pooled together with subgroup 2 (CRS 3–4). In group B the median DFS was 13 (95% CI 9–17) months and the median OS was 65 (95% CI 44–86) months. The Nordlinger score was of predictive value both before and after administration of neoadjuvant chemotherapy. In these CRS subgroups a significant difference was found in OS: P = 0.007 before neoadjuvant chemotherapy and P = 0.010 after neoadjuvant chemotherapy.
Table 3
Kaplan-Meyer analysis of disease-free survival in patients with and without chemotherapy
Scoring system
Without neoadjuvant chemotherapy (group A)
Before neoadjuvant chemotherapy (group B1)
After neoadjuvant chemotherapy (group B2)
n
Median time (months)
95% CI
3 years (%)
P-value
n
Median time (months)
95% CI
3 years (%)
P-value
n
Median time (months)
95% CI
3 years (%)
P-value
Nordlinger
150
16
12–20
40
0.028a
101
13
9–17
36
0.458a
101
13
9–17
36
0.173a
 0–2
87
18
0–43
46
 
37
13
5–22
38
 
47
14
7–23
40
 
 3–4
59
15
11–19
34
 
60
13
6–20
36
 
53
12
7–17
33
 
 5–6
4
4
0–12
0
 
4
3
0–9
0
 
1
–
–
–
 
Fong
150
16
12–20
40
<0.001
101
13
9–17
36
0.603
101
13
9–17
36
0.096
 0–2
123
21
3–39
47
 
54
13
3–23
38
 
70
14
6–22
39
 
 3–5
27
10
8–12
11
 
47
12
7–17
34
 
31
7
3–11
29
 
Nagashima
193
14
11–17
35
0.001a
159
9
7–11
26
0.030a
159
9
7–11
26
0.001a
 0–1
112
18
10–26
44
 
61
13
6–20
32
 
72
14
8–20
34
 
 2–3
77
10
7–13
24
 
94
7
5–9
22
 
84
6
5–7
18
 
 ≥4
4
11
5–17
0
 
4
6
–
25
 
3
6
–
–
 
Konopke
145
16
11–21
41
0.002
69
21
3–39
45
0.354
69
21
3–39
45
0.663
 0
91
37
12–61
51
 
13
41
–
61
 
15
41
0–83
59
 
 1
47
14
10–18
29
 
38
21
0–44
45
 
46
20
6–34
41
 
 ≥2
7
9
0–22
0
 
18
6
0–14
32
 
8
6
0–14
38
 
CI confidence interval, CRS clinical risk score
aAs a result of the small numbers of patients, CRS subgroup 3 (CRS ≥4) was pooled together with subgroup 2 (CRS 2–3)
TABLE 4
Kaplan-Meyer analysis of overall survival in patients with and without chemotherapy
Scoring system
Without neoadjuvant chemotherapy (group A)
Before neoadjuvant chemotherapy (group B1)
After neoadjuvant chemotherapy (group B2)
n
Median time (months)
95% CI
5 years (%)
P-value
n
Median time (months)
95% CI
5 years (%)
P-value
n
Median time (months)
95% CI
5 years (%)
P-value
Nordlinger
150
48
33–63
45
0.006a
101
65
44–86
53
0.007a
101
65
44–86
53
0.010a
 0–2
87
66
36–96
51
 
37
65
NR
66
 
47
65
53–77
65
 
 3–4
59
42
23–61
39
 
60
47
20–74
46
 
53
46
29–63
41
 
 5–6
4
18
0–49
0
 
4
18
NR
0
 
1
–
–
–
 
Fong
150
48
33–63
45
0.001
101
65
44–86
53
0.592
101
65
44–86
53
0.003
 0–2
123
64
40–88
52
 
54
55
37–73
48
 
70
65
NR
58
 
 3–5
27
34
31–37
21
 
47
65
9–121
60
 
31
29
16–42
41
 
Nagashima
193
43
34–52
38
0.001a
159
47
33–61
47
0.122a
159
47
33–61
47
0.001a
 0–1
112
54
38–70
47
 
61
55
39–71
47
 
72
65
43–87
56
 
 2–3
77
33
23–43
28
 
94
43
18–68
47
 
84
335
26–44
38
 
 ≥4
4
34
20–48
0
 
4
23
8–37
0
 
3
23
20–26
0
 
Konopke
145
51
37–65
45
0.024
69
65
NR
56
0.092
69
65
NR
56
0.505
 0
91
66
39–93
52
 
13
NR
–
60
 
15
NR
–
63
 
 1
47
42
36–48
41
 
38
65
44–86
60
 
46
65
41–89
55
 
 ≥2
7
41
18–64
0
 
18
32
27–37
45
 
8
32
12–52
45
 
CI confidence interval, NR not reached, CRS clinical risk score
aAs a result of the small numbers of patients, CRS subgroup 3 (CRS ≥4) was pooled together with subgroup 2 (CRS 2–3)

Fong

The CRS of Fong could be applied to 150 patients in group A and to 101 patients in group B (Table 1).
In group A the median DFS was 16.0 (95% CI 12–20) months, and the median OS was 48 (95% CI 33–63) months (Tables 3, 4). There was a significant difference between the CRS subgroups for DFS and OS (P < 0.001 and P = 0.001, respectively).
In group B the median DFS was 13 (95% CI 9–17) months, and the median OS was 65 (95% CI 44–86) months. Fong’s score was not of statistically significant predictive value when calculated before neoadjuvant chemotherapy. In the CRS subgroups no significant difference was found for OS (P = 0.592). After neoadjuvant chemotherapy, a significant difference (P = 0.003) was found between the CRS subgroups for OS.

Nagashima

The CRS of Nagashima could be applied to 193 patients in group A and to 159 patients in group B (Table 1).
In group A, the median DFS was 14 (95% CI 11–17) months and the median OS was 43 (95% CI 34–52) months (Tables 3, 4). In the CRS subgroups a significant difference was found for DFS and OS (P = 0.001 and P = 0.001, respectively). Because of the small numbers of patients, the CRS subgroup 3 (CRS ≥ 4) was pooled together with subgroup 2 (CRS 2–3).
In group B, the median DFS was 9 (95% CI 7–11) months and for OS the median was 47 (95% CI 33–61) months. When calculated before neoadjuvant chemotherapy Nagashima’s score was not of significant predictive value, and no significant difference (P = 0.122) was found between the CRS subgroups for OS. However, after neoadjuvant chemotherapy, a significant difference (P = 0.001) was found between the CRS subgroups for OS.

Konopke

The CRS of Konopke could be applied to 145 patients in group A and to 69 patients in group B (Table 1).
In group A the median DFS was 16 (95% CI 11–21) months, and the median OS was 51 (95% CI 37–65) months (Tables 3, 4). Between the CRS subgroups a significant difference was found in DFS and OS (P = 0.002 and P = 0.024, respectively).
In group B the median DFS was 21 (95% CI 3–39) months, and the median OS was 65 months (the 95% CI could not be calculated by the SPSS software). There was no significant difference between the subgroups in OS, either before or after administration of neoadjuvant chemotherapy (P = 0.092 and P = 0.505, respectively).

Survival Outcome after Neoadjuvant Chemotherapy

Patients with a lower CRS after neoadjuvant chemotherapy, compared to before chemotherapy, had the same survival outcome as patients with the same score but who did not have chemotherapy. For Nagashima’s score, patients with a lower CRS after neoadjuvant chemotherapy had an even better survival outcome than patients with the same score who did not undergo chemotherapy (P = 0.009).

Discussion

Until now, CRSs have not been evaluated for patients undergoing neoadjuvant chemotherapy before resection of CRLM. The present study evaluated CRSs in patients who received neoadjuvant chemotherapy before resection of liver metastases, and in patients who did not receive neoadjuvant chemotherapy.
Our results confirm that the CRSs of Nordlinger, Fong, Nagashima and Konopke could be applied to patients without neoadjuvant chemotherapy; however, when assessed before neoadjuvant chemotherapy, not all the CRSs are applicable.
A recent study evaluated eight prognostic scoring systems whereas we examined only four CRSs.23 Our reason for not investigating more scoring systems was because we lacked data on some variables used for these scores. For example, the score of Ueno et al. uses a pathological factor ‘tumor budding’ which is not reported for all patients in our clinic.16 Rees et al. include the differentiation of the primary tumor in the score; however, because we are a referral center most patients had their primary tumor resected elsewhere and we were unable to obtain all information required for this score.14 Schindl et al. use specific laboratory findings in their score, but these variables were not available in our prospectively recorded database.13
Generally, CRSs are not used to determine the possibility of surgery in a patient with CRLM, but mainly to assess the prognosis of this group of patients after successful surgery. To compare results of different studies, it is helpful to assess outcome with knowledge of disease severity. The CRSs can be helpful in these cases and are often used.2,24 However, use of effective neoadjuvant chemotherapy might influence the value of the widely used CRSs.
Small et al. hypothesized that the power of prediction of Fong’s score is reduced as a result of the effects of chemotherapy.20 To our knowledge, the present study is the first to explore this hypothesis in a single-center database with four CRSs in patients treated with neoadjuvant chemotherapy. Our results support the finding that when the CRS is calculated before starting neoadjuvant chemotherapy it is of no predictive value; however, we demonstrate that the scores are applicable when the score is addressed after administration of neoadjuvant chemotherapy. Konopke et al. described 43 patients who received neoadjuvant chemotherapy.12 In their study, the factors concerning liver-related oncological status were determined intraoperatively. Konopke et al. also confirmed the prognostic value of their scoring system in the patients who received neoadjuvant chemotherapy. This means that the score was determined after receiving neoadjuvant chemotherapy so one would expect this score to be applicable. However, we could not demonstrate the same result in our group of patients.
In the present study, chemotherapy downstaged the size and the CEA level. When the pathology report was consulted and complete response was reported, then the number of metastases also decreased significantly from a mean of 3.19 ± 1.95 to 2.64 ± 1.96 (P < 0.001). This effect changes the CRS. Patients who had a higher risk score before chemotherapy became patients with a lower risk score after chemotherapy, with an associated improved survival. Bilobar disease showed no statistically significant change after administration of neoadjuvant chemotherapy, and extrahepatic disease did not change at all.
In conclusion, in the era of effective neoadjuvant chemotherapy, the traditional CRSs may no longer be a reliable predictive tool. On the basis of our findings, if prediction of prognosis is required, all the traditional CRSs can be used if they are determined after treatment with neoadjuvant chemotherapy. If a prognosis is required before starting neoadjuvant therapy, only the Nordlinger CRS is of statistically significant prognostic value.

Conflict of interest

None.

Open Access

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
Open AccessThis is an open access article distributed under the terms of the Creative Commons Attribution Noncommercial License (https://​creativecommons.​org/​licenses/​by-nc/​2.​0), which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
insite
INHALT
download
DOWNLOAD
print
DRUCKEN

Unsere Produktempfehlungen

Die Chirurgie

Print-Titel

Das Abo mit mehr Tiefe

Mit der Zeitschrift Die Chirurgie erhalten Sie zusätzlich Online-Zugriff auf weitere 43 chirurgische Fachzeitschriften, CME-Fortbildungen, Webinare, Vorbereitungskursen zur Facharztprüfung und die digitale Enzyklopädie e.Medpedia.

Bis 30. April 2024 bestellen und im ersten Jahr nur 199 € zahlen!

Jetzt informieren

e.Med Interdisziplinär

Kombi-Abonnement

Für Ihren Erfolg in Klinik und Praxis - Die beste Hilfe in Ihrem Arbeitsalltag

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de.

Jetzt testen 1
Literatur
1.
Bengmark S, Hafstrom L. The natural history of primary and secondary malignant tumors of the liver. I. The prognosis for patients with hepatic metastases from colonic and rectal carcinoma by laparotomy. Cancer. 1969;23:198–202.PubMedCrossRef
2.
van der Pool AE, Lalmahomed ZS, Ozbay Y, et al. “Staged” liver resection in synchronous and metachronous colorectal hepatic metastases; differences in clinicopathological features and outcome. Colorectal Dis. 2009;12:e229–35.
3.
Adam R, Avisar E, Ariche A, et al. Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal. Ann Surg Oncol. 2001;8:347–53.PubMedCrossRef
4.
Nikfarjam M, Shereef S, Kimchi ET, et al. Survival outcomes of patients with colorectal liver metastases following hepatic resection or ablation in the era of effective chemotherapy. Ann Surg Oncol. 2009;16:1860–7.PubMedCrossRef
5.
Scheele J, Altendorf-Hofmann A. Resection of colorectal liver metastases. Langenbecks Arch Surg. 1999;384:313–27.PubMedCrossRef
6.
Giacchetti S, Itzhaki M, Gruia G, et al. Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery. Ann Oncol. 1999;10:663–9.PubMedCrossRef
7.
Minagawa M, Yamamoto J, Kosuge T, et al. Simplified staging system for predicting the prognosis of patients with resectable liver metastasis: development and validation. Arch Surg. 2007;142:269–76.PubMedCrossRef
8.
Nordlinger B, Guiguet M, Vaillant JC, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer. 1996;77:1254–62.PubMedCrossRef
9.
Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309–18.PubMedCrossRef
10.
Iwatsuki S, Dvorchik I, Madariaga JR, et al. Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system. J Am Coll Surg. 1999;189:291–9.PubMedCrossRef
11.
Nagashima I, Takada T, Matsuda K, et al. A new scoring system to classify patients with colorectal liver metastases: proposal of criteria to select candidates for hepatic resection. J Hepatobiliary Pancreat Surg. 2004;11:79–83.PubMedCrossRef
12.
Konopke R, Kersting S, Distler M, et al. Prognostic factors and evaluation of a clinical score for predicting survival after resection of colorectal liver metastases. Liver Int. 2009;29:89–102.PubMedCrossRef
13.
Schindl M, Wigmore SJ, Currie EJ, et al. Prognostic scoring in colorectal cancer liver metastases: development and validation. Arch Surg. 2005;140:183–9.PubMedCrossRef
14.
Rees M, Tekkis PP, Welsh FK, et al. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008;247:125–35.PubMedCrossRef
15.
Lise M, Bacchetti S, Da Pian P, et al. Patterns of recurrence after resection of colorectal liver metastases: prediction by models of outcome analysis. World J Surg. 2001;25:638–44.PubMedCrossRef
16.
Ueno H, Mochizuki H, Hatsuse K, et al. Indicators for treatment strategies of colorectal liver metastases. Ann Surg. 2000;231:59–66.PubMedCrossRef
17.
Zakaria S, Donohue JH, Que FG, et al. Hepatic resection for colorectal metastases: value for risk scoring systems? Ann Surg. 2007;246:183–91.PubMedCrossRef
18.
Merkel S, Bialecki D, Meyer T, et al. Comparison of clinical risk scores predicting prognosis after resection of colorectal liver metastases. J Surg Oncol. 2009;100:349–57.PubMedCrossRef
19.
Reissfelder C, Rahbari NN, Koch M, et al. Validation of prognostic scoring systems for patients undergoing resection of colorectal cancer liver metastases. Ann Surg Oncol. 2009;16:3279–88.PubMedCrossRef
20.
Small RM, Lubezky N, Shmueli E, et al. Response to chemotherapy predicts survival following resection of hepatic colo-rectal metastases in patients treated with neoadjuvant therapy. J Surg Oncol. 2009;99:93–8.PubMedCrossRef
21.
Arru M, Aldrighetti L, Castoldi R, et al. Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer. World J Surg. 2008;32:93–103.PubMedCrossRef
22.
Mann CD, Metcalfe MS, Leopardi LN, et al. The clinical risk score: emerging as a reliable preoperative prognostic index in hepatectomy for colorectal metastases. Arch Surg. 2004;139:1168–72.PubMedCrossRef
23.
Sotiropoulos GC, Lang H. Clinical scoring systems for predicting outcome after surgery for colorectal liver metastases: towards a better multidisciplinary approach. Liver Int. 2009;29:6–9.PubMedCrossRef
24.
Mentha G, Terraz S, Morel P, et al. Dangerous halo after neoadjuvant chemotherapy and two-step hepatectomy for colorectal liver metastases. Br J Surg. 2009;96:95–103.PubMedCrossRef
Metadaten
Titel
Is the Clinical Risk Score for Patients with Colorectal Liver Metastases Still Useable in the Era of Effective Neoadjuvant Chemotherapy?
verfasst von
Ninos Ayez, MD
Zarina S. Lalmahomed, MD
Anne E. M. van der Pool, MD
Yvonne Vergouwe, PhD
Kees van Montfort, PhD
Jeroen de Jonge, MD, PhD
Alexander M. M. Eggermont, MD, PhD
Jan N. M. IJzermans, MD, PhD
Cornelis Verhoef, MD, PhD
Publikationsdatum
01.10.2011
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 10/2011
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1819-8

Weitere Artikel der Ausgabe 10/2011

Annals of Surgical Oncology 10/2011 Zur Ausgabe

Gastrointestinal Oncology

Tumor Size and Depth Predict Rate of Lymph Node Metastasis and Utilization of Lymph Node Sampling in Surgically Managed Gastric Carcinoids

Gastrointestinal Oncology

A Comparison of POSSUM and GPS Models in the Prediction of Post-operative Outcome in Patients Undergoing Oesophago-gastric Cancer Resection

Breast Oncology

Ductal Carcinoma-In-Situ of the Breast with Subsequent Distant Metastasis and Death

Healthcare Policy and Outcomes

Intraoperative Epidural Analgesia Prevents the Early Proinflammatory Response to Surgical Trauma. Results from a Prospective Randomized Clinical Trial of Intraoperative Epidural Versus General Analgesia

Colorectal Cancer

MRI-Based Indications for Neoadjuvant Radiochemotherapy in Rectal Carcinoma: Interim Results of a Prospective Multicenter Observational Study

Head and Neck Oncology

Low-Dose Preoperative Chemoradiation Therapy Compared with Surgery Alone with or Without Postoperative Radiotherapy in Patients with Head and Neck Carcinoma

Neu im Fachgebiet Chirurgie

17.04.2024 | Postoperative nausea and vomiting | Nachrichten

Hochrisiko-Eingriffe für postoperative Übelkeit

16.04.2024 | HNO-Chirurgie | Nachrichten

HNO-Op. auch mit über 90?

16.04.2024 | Infektiologie | Nachrichten

Kein Abstrich bei chronischen Wunden ohne Entzündungszeichen!

10.04.2024 | Postoperative Schmerztherapie | Nachrichten

Chronische Schmerzen nach Op. oft mit neuropathischer Komponente
weitere anzeigen

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom CME-Kurs
CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur CME-Kurs
CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis CME-Kurs
CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.