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Research article
Bao-Cai Xing
Peking University School of Oncology
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9854-2726
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Local treatment remains the best option for recurrent colorectal liver metastasis. The current study aims to investigate predictive factors of survival outcomes and select candidates of local treatment for CRLM at first recurrence.
Methods
Data were collected retrospectively on CRLM patients who underwent hepatic resection and developed first recurrence between 2000 and 2019 at our institution. A nomogram to predict overall survival was established based on a multivariable Cox model of clinicopathologic factors. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index and calibration curve.
Results
Among 867 patients who underwent curative hepatic resection, 549 patients developed recurrence. Three hundred patients were evaluated to be resectable and liver-limited disease. Among of them, repeat liver resection and percutaneous radiofrequency ablation were performed in 88 and 85 patients, respectively. The other 127 patients only received systemic chemotherapy. Multivariable analysis identified node-positive primary, tumor size > 3 cm, early recurrence, RAS gene mutation and no local treatment were independent risk factors for survival outcome. Integrating these five variables, the nomogram showed good concordance statistics of 0.707. Compared with patients who only received systemic chemotherapy, radical local treatment did not improve survival outcome significantly (median OS: 21 vs. 15 months, p = 0.126) in high risk group (total score above 13).
Conclusion
Radical local treatment is crucial to prolong the survival of recurrent CRLM patients. The proposed model facilitates personalized assessment of prognosis for patients who developed first recurrence in liver.
Keywords
CRLM, recurrence, repeat, resection, RFA
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- SupplementaryFigure1.pdf
Flowchart of the enrolled cohorts.
- SupplementaryFigure2.jpg
The definition of early recurrence using the minimum p value approach by optimal cutoff point regarding the time to first recurrence.
- SupplementaryFigure3.jpeg
Kaplan-Meier Curve showing OS and DFS of 867 patients.
- SupplementaryFigure4.jpeg
Kaplan-Meier Curve showing OS and DFS of local treatment.
- SupplementaryFigure5.jpg
The OS of high risk (score>13) and low risk groups (score≤13) by Kaplan-Meier Curve.
- SupplementaryFigure6.jpeg
The OS of local treatment and chemotherapy in high risk group by Kaplan-Meier Curve.
- SupplementaryFigure7.jpeg
Kaplan-Meier Curve showing OS of local treatment and chemotherapy in high risk group.
- SupplementaryTable1.docx
Prognostic factor points
- SupplementaryTable2.docx
Comparison of different models in predicting OS.
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CURRENT STATUS: Published
View the published article at BMC Surgery.
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Posted 18 Jan, 2021
No community comments so far
Review #2 received
Received 05 May, 2021
Editorial decision: Major revision
On 05 May, 2021
Reviewer #4 agreed
On 03 May, 2021
Reviewer #3 agreed
On 02 May, 2021
Review #1 received
Received 09 Feb, 2021
Reviewer #2 agreed
On 02 Feb, 2021
Reviewer #1 agreed
On 19 Jan, 2021
Reviewers invited
Invitations sent on 18 Jan, 2021
Editor assigned
On 22 Dec, 2020
Submission checks complete
On 22 Dec, 2020
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On 22 Dec, 2020
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Surgery.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Bao-Cai Xing
Peking University School of Oncology
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9854-2726
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Surgery.
Version 1
Posted 18 Jan, 2021
No community comments so far
Review #2 received
Received 05 May, 2021
Editorial decision: Major revision
On 05 May, 2021
Reviewer #4 agreed
On 03 May, 2021
Reviewer #3 agreed
On 02 May, 2021
Review #1 received
Received 09 Feb, 2021
Reviewer #2 agreed
On 02 Feb, 2021
Reviewer #1 agreed
On 19 Jan, 2021
Reviewers invited
Invitations sent on 18 Jan, 2021
Editor assigned
On 22 Dec, 2020
Submission checks complete
On 22 Dec, 2020
Editor invited
On 22 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Surgery.
Background
Local treatment remains the best option for recurrent colorectal liver metastasis. The current study aims to investigate predictive factors of survival outcomes and select candidates of local treatment for CRLM at first recurrence.
Methods
Data were collected retrospectively on CRLM patients who underwent hepatic resection and developed first recurrence between 2000 and 2019 at our institution. A nomogram to predict overall survival was established based on a multivariable Cox model of clinicopathologic factors. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index and calibration curve.
Results
Among 867 patients who underwent curative hepatic resection, 549 patients developed recurrence. Three hundred patients were evaluated to be resectable and liver-limited disease. Among of them, repeat liver resection and percutaneous radiofrequency ablation were performed in 88 and 85 patients, respectively. The other 127 patients only received systemic chemotherapy. Multivariable analysis identified node-positive primary, tumor size > 3 cm, early recurrence, RAS gene mutation and no local treatment were independent risk factors for survival outcome. Integrating these five variables, the nomogram showed good concordance statistics of 0.707. Compared with patients who only received systemic chemotherapy, radical local treatment did not improve survival outcome significantly (median OS: 21 vs. 15 months, p = 0.126) in high risk group (total score above 13).
Conclusion
Radical local treatment is crucial to prolong the survival of recurrent CRLM patients. The proposed model facilitates personalized assessment of prognosis for patients who developed first recurrence in liver.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- SupplementaryFigure1.pdf
Flowchart of the enrolled cohorts.
- SupplementaryFigure2.jpg
The definition of early recurrence using the minimum p value approach by optimal cutoff point regarding the time to first recurrence.
- SupplementaryFigure3.jpeg
Kaplan-Meier Curve showing OS and DFS of 867 patients.
- SupplementaryFigure4.jpeg
Kaplan-Meier Curve showing OS and DFS of local treatment.
- SupplementaryFigure5.jpg
The OS of high risk (score>13) and low risk groups (score≤13) by Kaplan-Meier Curve.
- SupplementaryFigure6.jpeg
The OS of local treatment and chemotherapy in high risk group by Kaplan-Meier Curve.
- SupplementaryFigure7.jpeg
Kaplan-Meier Curve showing OS of local treatment and chemotherapy in high risk group.
- SupplementaryTable1.docx
Prognostic factor points
- SupplementaryTable2.docx
Comparison of different models in predicting OS.
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