Current status and clinical application of the prognostic scoring system for colorectal liver metastasis

doi:10.3969/j.issn.1009-976X.2021.01.003

Abstract

Abstract: Colorectal cancer is the second most common malignant tumor in China, and about 50% of patients will have liver metastases. Effective systemic treatment and active local treatment including surgery are the key to improving the efficacy of patients with colorectal liver metastasis. Recurrence after hepatectomy is the main cause of death in patients with colorectal liver metastasis. The treatment options for patients with different recurrence risks are also different. Therefore, it is very important to establish an effective prognostic scoring system for colorectal liver metastasis to guide its individualized treatment. Clinical Risk Score （CRS） is currently the most widely used prognostic scoring system for patients with colorectal liver metastasis. Other prognostic scoring systems include Tumor Burden Score （TBS）, Genetic And Morphological Evaluation （GAME） score, and Comprehensive Evaluation of Relapse Risk （CERR） score. The continuous improvement of the prognosis scoring system can better help clinicians predict the prognosis of patients with colorectal liver metastasis, and adopt more active intervention methods for high-risk patients to reasonably and effectively prolong the lives of patients.

Key words: colorectal cancer, Colorectal Liver Metastasis, prognosis scoring system, clinical risk score

摘要： 结直肠癌是中国第二常见的恶性肿瘤,其中约50％的患者最终会发生肝转移。有效的全身治疗和积极包括手术在内的局部治疗,是提升结直肠癌肝转移患者疗效的关键。肝切除术后复发是导致结直肠癌肝转移患者死亡的主要原因,不同复发风险的患者治疗选择也有所不同,因此建立有效的结直肠癌肝转移预后评分系统,以指导其个体化治疗至关重要。临床危险评分（CRS）是目前结直肠癌肝转移患者应用最广泛的预后评分系统。其他预后评分系统还包括肿瘤负荷评分（TBS）、GAME评分、CERR评分等。预后评分系统的不断完善可以更好地帮助临床医生预测结直肠癌肝转移病人预后,对高危患者采取更积极的干预手段,合理有效地延长患者生命。

关键词: 结直肠癌, 结直肠癌肝转移, 预后评分系统, 临床危险评分

CLC Number:

ZHANG Guo, ZHANG Rui, CHEN Jin-hong. Current status and clinical application of the prognostic scoring system for colorectal liver metastasis[J]. Lingnan Modern Clinics In Surgery, 2021, 21(01): 11-16.

张果, 张瑞, 陈进宏. 结直肠癌肝转移预后评分系统的现状及临床应用[J]. 岭南现代临床外科, 2021, 21(01): 11-16.

References

[1] Feng RM, Zong YN, Cao SM, et al.Current Cancer Situation in China:Good or Bad News from the 2018 Global Cancer Statistics?[J]. Cancer Commun (Lond), 2019, 39(1): 22.
[2] Bray F, Ferlay J, Soerjomataram I, et al.Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424.
[3] Van Cutsem E, Nordlinger B, Cervantes A, et al.Advanced colorectal cancer:ESMO Clinical Practice Guidelines for treatment[J]. Ann Oncol 2010, 21(Suppl 5): v93-v97.
[4] de Jong MC, Pulitano C, Ribero D, et al. Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis:An international multi-institutional analysis of 1669 patients[J]. Ann Surg, 2009, 250(3): 440-448.
[5] 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[J]. Ann Surg, 1999, 230(3): 309-321.
[6] 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 Française de Chirurgie[J]. Cancer, 1996, 77(7): 1254-1262.
[7] Iwatsuki S, Dvorchik I, Madariaga JR, et al.Hepatic resection for metastatic colorectal adenocarcinoma:a proposal of a prognostic scoring system[J]. J Am Coll Surg, 1999, 189(3): 291-299.
[8] 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]. J Hepatobiliary Pancreat Surg, 2004, 11(2): 79-83.
[9] Rees M, Tekkis PP, welsh FK, et a1. Evaluation of long-term survival after hepatic resection for metastatic eolorectal cancer:a muhifactorial model of 929 patients[J]. Ann Surg, 2008, 247(1): 125-135.
[10] Vauthey JN, Zimmitti G, Kopetz SE, et al.RAS mutation status predicts survival and patterns of recurrence in patients undergoing hepatectomy for colorectal liver metastases[J]. Ann Surg, 2013, 258(4): 619-627.
[11] Brudvik KW, Jones RP, Giuliante F, et al.RAS Mutation Clinical Risk Score to Predict Survival After Resection of Colorectal Liver Metastases[J]. Ann Surg, 2019, 269(1): 120-126.
[12] Sasaki K, Morioka D, Conci S, et al.The Tumor Burden Score: A New “Metro-ticket” Prognostic Tool For Colorectal Liver Metastases Based on Tumor Size and Number of Tumors.[J]. Ann Surg, 2018, 267(1): 132-141.
[13] Mao R, Zhao JJ, Bi XY, et al.Interaction of margin status and tumour burden determines survival after resection of colorectal liver metastases:A retrospective cohort study[J]. Int J Surg, 2018, 53: 371-377.
[14] Margonis GA, Sasaki K, Gholami S, et al.Genetic And Morphological Evaluation (GAME) score for patients with colorectal liver metastases[J]. Br J Surg, 2018, 105(9): 1210-1220.
[15] Chen YJ, Chang WJ, Ren L, et al.Comprehensive Evaluation of Relapse Risk (CERR) Score for Colorectal Liver Metastases:Development and Validation[J]. Oncologist, 2020, 25(7): e1031-e1041.
[16] Mann CD, Metcalfe MS, Leopardi LN, et al.The clinical risk score:emerging as a reliable preoperative prognostic index in hepatectomy for colorectal metastases.[J]. Arch Surg, 2004, 139(11): 1168-1172.
[17] Shin SJ, Ahn JB, Choi JS, et al.Implications of clinical risk score to predict outcomes of liver-confined metastasis of colorectal cancer[J]. Surg Oncol, 2012, 21(3): e125-e130.
[18] 闫晓峦, 王崑, 包全, 等. 结直肠癌肝转移患者临床风险评分体系的预后评价[J].中华肝胆外科杂志, 2015, 21(6): 388-392.
[19] Jarnagin WR, Conlon K, Bodniewicz J, et al.A clinical scoring system predicts the yield of diagnostic laparoscopy in patients with potentially resectable hepatic colorectal metastases[J]. Cancer, 2001, 91(6): 1121-1128.
[20] Shah AJ, Phull J, Finch-Jones MD.Clinical Risk Score Can be Used to Select Patients for Staging Laparoscopy and Laparoscopic Ultrasound for Colorectal Liver Metastases[J]. World J Surg, 2010, 34(9): 2141-2145.
[21] Grothey A, Sobrero AF, Shields AF, et al.Duration of Adjuvant Chemotherapy for Stage III Colon Cancer[J]. N Engl J Med, 2018, 378(13): 1177-1188.
[22] Kanemitsu Y, Kato T, Shimizu Y, et al.A randomized phase II/III trial comparing hepatectomy followed by mFOLFOX6 with hepatectomy alone for liver metastasis from colorectal cancer: JCOG0603 study[J]. JCO, 2020, 38: 4005.
[23] Rahbari NN, Reissfelder C, Schulze-Bergkamen H, et al.Adjuvant therapy after resection of colorectal liver metastases:the predictive value of the MSKCC clinical risk score in the era of modern chemotherapy[J]. BMC Cancer, 2014, 14(1): 174.
[24] Nordlinger B, Sorbye H, Glimelius B, et al.Perioperative chemotherapy with FOLFOX4 and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC Intergroup trial 40983): a randomised controlled trial[J]. Lancet, 2008, 371(9617): 1007-1016.
[25] Nordlinger B, Sorbye H, Glimelius B, et al.Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer (EORTC 40983): long-term results of a randomised, controlled, phase 3 trial[J]. Lancet Oncol, 2013, 14(12): 1208-1215.
[26] Primrose J, Falk S, Finch-Jones M, et al.Systemic chemotherapy with or without cetuximab in patients with resectable colorectal liver metastasis:the New EPOC randomised controlled trial[J]. Lancet Oncol, 2014, 15(6): 601-611.
[27] Benson AB, Venook AP, Al-Hawary MM, et al.NCCN Guidelines Insights:Colon Cancer, Version 2.2018.[J]. J Natl Compr Canc Netw, 2018, 16(4): 359-369.
[28] Van Cutsem E, Cervantes A, Adam R, et al.ESMO consensus guidelines for the management of patients with metastatic colorectal cancer[J]. Ann Oncol, 2016, 27(8): 1386-1422.
[29] Ayez N, van der Stok EP, Grunhagen DJ, et al. The use of neo-adjuvant chemotherapy in patients with resectable colorectal liver metastases:Clinical risk score as possible discriminator[J]. Eur J Surg Oncol, 2015, 41(7): 859-867.
[30] Ayez N, Lalmahomed ZS, van der Pool AE, et al. Is the Clinical Risk Score for Patients with Colorectal Liver Metastases Still Useable in the Era of Effective Neoadjuvant Chemotherapy?[J]. Ann Surg Oncol, 2011, 18(10): 2757-2763.
[31] Wimmer K, Schwarz C, Szabo C, et al.Impact of Neoadjuvant Chemotherapy on Clinical Risk Scores and Survival in Patients with Colorectal Liver Metastases[J]. Ann Surg Oncol, 2017, 24(1): 236-243.
[32] Wang XY, Zhang R, Wang Z, et al.Meta-analysis of the association between primary tumour location and prognosis after surgical resection of colorectal liver metastases[J]. Br J Surg, 2019, 106(13): 1747-1760.