TY - JOUR
T1 - Predicting early extrahepatic recurrence after local treatment of colorectal liver metastases
AU - Wensink, G. E.
AU - Bolhuis, Karen
AU - Elferink, Marloes A.G.
AU - Fijneman, Remond J.A.
AU - Kranenburg, Onno
AU - Borel Rinkes, Inne H.M.
AU - Koopman, Miriam
AU - Swijnenburg, Rutger Jan
AU - Vink, Geraldine R.
AU - Hagendoorn, Jeroen
AU - Punt, Cornelis J.A.
AU - Roodhart, Jeanine M.L.
AU - Elias, Sjoerd G.
N1 - Funding Information:
This research was supported by a grant from the Sacha Swarttouw-Hijmans Fund. G.E.W. and K.B. are joint first authors, and J.M.L.R. and S.G.E. are joint last authors, of this article. The authors thank the registration team of the IKNL for the collection of data for the NCR; IKNL staff for scientific advice; NKI-AVL Core Facility Molecular Pathology & Biobanking for providing laboratory support; and W. Hoefakker and P. van Diemen for mutational analysis and their contribution to the study.
Publisher Copyright:
© The Author(s) 2023.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - Background: Patients who develop early extrahepatic recurrence (EHR) may not benefit from local treatment of colorectal liver metastases (CRLMs). This study aimed to develop a prediction model for early EHR after local treatment of CRLMs using a national data set. Methods: A Cox regression prediction model for EHR was developed and validated internally using data on patients who had local treatment for CRLMs with curative intent. Performance assessment included calibration, discrimination, net benefit, and generalizability by internal–external cross-validation. The prognostic relevance of early EHR (within 6 months) was evaluated by landmark analysis. Results: During a median follow-up of 35 months, 557 of the 1077 patients had EHR and 249 died. Median overall survival was 19.5 (95 per cent c.i. 15.6 to 23.0) months in patients with early EHR after CRLM treatment, compared with not reached (45.3 months to not reached) in patients without an early EHR. The EHR prediction model included side and stage of the primary tumour, RAS/BRAFV600E mutational status, and number and size of CRLMs. The range of 6-month EHR predictions was 5.9–56.0 (i.q.r. 12.9–22.0) per cent. The model demonstrated good calibration and discrimination. The C-index through 6 and 12 months was 0.663 (95 per cent c.i. 0.624 to 0.702) and 0.661 (0.632 to 0.689) respectively. The observed 6-month EHR risk was 6.5 per cent for patients in the lowest quartile of predicted risk compared with 32.0 per cent in the highest quartile. Conclusion: Early EHR after local treatment of CRLMs can be predicted.
AB - Background: Patients who develop early extrahepatic recurrence (EHR) may not benefit from local treatment of colorectal liver metastases (CRLMs). This study aimed to develop a prediction model for early EHR after local treatment of CRLMs using a national data set. Methods: A Cox regression prediction model for EHR was developed and validated internally using data on patients who had local treatment for CRLMs with curative intent. Performance assessment included calibration, discrimination, net benefit, and generalizability by internal–external cross-validation. The prognostic relevance of early EHR (within 6 months) was evaluated by landmark analysis. Results: During a median follow-up of 35 months, 557 of the 1077 patients had EHR and 249 died. Median overall survival was 19.5 (95 per cent c.i. 15.6 to 23.0) months in patients with early EHR after CRLM treatment, compared with not reached (45.3 months to not reached) in patients without an early EHR. The EHR prediction model included side and stage of the primary tumour, RAS/BRAFV600E mutational status, and number and size of CRLMs. The range of 6-month EHR predictions was 5.9–56.0 (i.q.r. 12.9–22.0) per cent. The model demonstrated good calibration and discrimination. The C-index through 6 and 12 months was 0.663 (95 per cent c.i. 0.624 to 0.702) and 0.661 (0.632 to 0.689) respectively. The observed 6-month EHR risk was 6.5 per cent for patients in the lowest quartile of predicted risk compared with 32.0 per cent in the highest quartile. Conclusion: Early EHR after local treatment of CRLMs can be predicted.
UR - http://www.scopus.com/inward/record.url?scp=85148250182&partnerID=8YFLogxK
U2 - 10.1093/bjs/znac461
DO - 10.1093/bjs/znac461
M3 - Article
C2 - 36655278
AN - SCOPUS:85148250182
SN - 0007-1323
VL - 110
SP - 362
EP - 371
JO - British Journal of Surgery
JF - British Journal of Surgery
IS - 3
ER -