Score predicts survival after surgery for liver mets from colorectal cancer

Surgery to remove colorectal cancer that has spread to the liver has excellent outcomes in some patients.  A percentage will be alive and cancer-free five years after surgery.  But predicting which patients will benefit can be difficult.

Using only two factors that could be measured before surgery, doctors have developed a simple predictive score of the probability that a patient will be alive five years after surgery.

Scoring depends on two items:

• 8 or more metastatic tumors in the liver
• presence of inflammatory response to tumor (IRT)

When tumor cells enter the liver, there may be an inflammatory response that pathologists believe contributes to the development of a new tumor or liver metastasis.  Inflammatory response to tumor in this study was defined using two markers of inflammation, either:

• elevated C-reactive protein over 10 mg/L, or
• a neutrophil/lymphocyte ratio (NLR) greater than 5:1

Scoring was from 0 to 2 with

• 0 — fewer than 8 metastatic tumors and no inflammatory response
• 1 — either 8 or more mets or inflammatory response to tumor
• 2 — both 8 or more mets and inflammatory response

Surgeons kept records for almost 700 patients who had surgery to remove liver metastases from colorectal cancer from 1993 through 2006.  By measuring the number of mets and the presence or absence of inflammatory response to tumor, they found that:

• Overall five year survival for the entire group was 45 percent.
• Five year survival for patients with a score of 0 was 49 percent
• Five year survival for those with a score of 1 was 34 percent.
• No patients with a score of 2 were alive at five years.

Hassan Z. Malik MD, FRCS and colleagues concluded

The preoperative prognostic score is a simple and effective system allowing preoperative stratification.

SOURCE: Malik et al, Annals of Surgery, Volume 246, Issue 5, November 2007.