Author(s): Brudvik K.W.; Shindoh J.; Passot G.; Chung M.H.; Yamashita S.; Conrad C.; Aloia T.A.; Vauthey J.-N.; Fretland AA.; Rosok B.; Edwin B.; Bjornbeth B.A.; Jones R.P.; Poston G.J.; Giuliante F.; De Rose A.M.; Ardito F.; Panettieri E.; Song J.; Li L.; Dagenborg V.J.; Larocca L.M.
Source: Annals of surgery; Jan 2019; vol. 269 (no. 1); p. 120-126
Publication Date: Jan 2019
Publication Type(s): Article
Available at Annals of Surgery – from Ovid (Journals @ Ovid) – Remote Access
Abstract:OBJECTIVE: To determine the impact of RAS mutation status on the traditional clinical score (t-CS) to predict survival after resection of colorectal liver metastases (CLM). BACKGROUND: The t-CS relies on the following factors: primary tumor nodal status, disease-free interval, number and size of CLM, and carcinoembryonic antigen level. We hypothesized that the addition of RAS mutation status could create a modified clinical score (m-CS) that would outperform the t-CS. METHOD(S): Patients who underwent resection of CLM from 2005 through 2013 and had RAS mutation status and t-CS factors available were included. Multivariate analysis was used to identify prognostic factors to include in the m-CS. Log-rank survival analyses were used to compare the t-CS and the m-CS. The m-CS was validated in an international multicenter cohort of 608 patients. RESULT(S): A total of 564 patients were eligible for analysis. RAS mutation was detected in 205 (36.3%) of patients. On multivariate analysis, RAS mutation was associated with poor overall survival, as were positive primary tumor lymph node status and diameter of the largest liver metastasis >50 mm. Each factor was assigned 1 point to produce a m-CS. The m-CS accurately stratified patients by overall and recurrence-free survival in both the initial patient series and validation cohort, whereas the t-CS did not. CONCLUSION(S): Modifying the t-CS by replacing disease-free interval, number of metastases, and CEA level with RAS mutation status produced an m-CS that outperformed the t-CS. The m-CS is therefore a simple validated tool that predicts survival after resection of CLM.