An updated scoring system for prediction of survival after resection of colorectal liver metastases: addition of KRAS status as an important risk modifier

摘要

Colorectal liver metastases (CRLM) were traditionally associated with a very poor prognosis after resection, with some historical series reporting 5-year survival rates as low as 14% for completely resected multiple metastases ( ). However, as modern chemotherapy and surgical techniques have evolved, there has been much progress made in improving survival for this unique group of patients, with 5-year survival approaching 55% with R0 resection ( ). However, not all CRLM are the same, with very different biological behaviour and ultimately oncologic outcomes in different patients. There have been many attempts to create a scoring system defining factors which will predict this behaviour, with the system created by Fong in 1999 being the most commonly employed ( ). These scoring systems are important because they help the selection of patients who are likely to benefit from surgical treatment of their metastases. Patients who are unlikely to benefit from surgical resection may be better treated by alternative and potentially less morbid therapies, such as the various forms of ablation, or with systemic treatments. It is apparent that the accuracy of this prediction is essential to allow patients to benefit either by having appropriate surgical therapy or by avoiding potentially unnecessary surgical morbidity.