Prognostic models for outcome following liver resection for colorectal cancer metastases: A systematic review

doi:10.1016/j.ejso.2011.10.013

European Journal of Surgical Oncology (EJSO)

Volume 38, Issue 1, January 2012, Pages 16-24

https://doi.org/10.1016/j.ejso.2011.10.013 Get rights and content

Abstract

Background

Liver resection provides the best chance for cure in colorectal cancer (CRC) liver metastases. A variety of factors that might influence survival and recurrence have been identified. Predictive models can help in risk stratification, to determine multidisciplinary treatment and follow-up for individual patients.

Aims

To systematically review available prognostic models described for outcome following resection of CRC liver metastases and to assess their differences and applicability.

Methods

The Pubmed, Embase and Cochrane Library databases were searched for articles proposing a prognostic model or risk stratification system for resection of CRC liver metastases. Search terms included ‘colorectal’, ‘liver’, ‘metastasis’, ‘resection’, ‘prognosis’ and ‘prediction’. The articles were systematically reviewed.

Results

Fifteen prognostic systems were identified, published between 1996 and 2009. The median study population was 305 patients and the median follow-up was 32 months. All studies used Cox proportional hazards for multi-variable analysis. No prognostic factor was common in all models, though there was a tendency towards the number of metastases, CRC spread to lymph nodes, maximum size of metastases, preoperative CEA level and extrahepatic spread as representing independent risk factors. Seven models assigned more weight to selected factors considered of higher predictive value.

Conclusion

The existing predictive models are diverse and their prognostic factors are often not weighed according to their impact. For the development of future predictive models, the complex relations within datasets and differences in relevance of individual factors should be taken into account, for example by using artificial neural networks.

Introduction

Yearly, about 1.2 million cases of colorectal cancer (CRC) occur worldwide, with approximately 195 200 newly diagnosed cases in North-Western Europe.¹ It is one of the most common malignancies and the third leading cause of cancer-related mortality in both men and women.² The general 5-year survival rate is estimated to be 65%, declining to 11% if distant metastases are present.³

Within three years after the diagnosis of CRC, 29% of the patients will develop liver metastases.⁴ This condition will be fatal if left untreated, with a median survival measured in months.5, 6 For patients with resectable liver metastases, a resection with curative intent is the treatment of choice, which renders a reported 5-year survival rate in the range of 38–58%.7, 8, 9, 10 By means of novel treatment strategies, such as portal vein embolisation (PVE), two-stage hepatectomy and preoperative down-sizing chemotherapy, together with more “aggressive” surgery due to increased safety of the procedure per se, the number of patients who are suitable for resection has gradually increased.11, 12, 13, 14, 15

Several previous study groups have examined prognostic factors for tumour recurrence and survival after liver resection for CRC metastases.16, 17, 18, 19, 20 The development of predictive models helps to stratify patients into risk categories for the selection of management strategies, to predict prognosis and possibly also to allow a more accurate evaluation of the influence and effectiveness of new therapeutic interventions. Currently, few such models are available, of which the most well known ones are those by Fong et al.,²¹ Rees et al.⁸ and Nordlinger et al.²² However, as is the case with these three, most models do not take into account that certain prognostic parameters are of greater influence than others. Furthermore, many of the available models are partly based on patients collected during the 1980s and even earlier,8, 22, 23, 24 making it questionable if these are applicable today. Hence there is need for the development of new predictive models, based on more recent study populations and especially with means to take the difference in impact of individual prognostic factors into account.

The aim of this systematic review was to evaluate currently available prognostic models for the outcome following resection of CRC liver metastases and to assess their differences and applicability in prognosis prediction and decision making.

Section snippets

Search strategy

A systematic review was performed to assess existing prognostic scoring systems and predictive models considering patients undergoing liver resection for colorectal cancer (CRC) metastases. The Pubmed, Embase and Cochrane Library databases were searched on December 18th 2010, using a syntax including synonyms for ‘colorectal’, ‘liver’, ‘metastasis’, ‘resection’, ‘prognosis’ and ‘prediction’ (Table 1). After removing duplicates, the remaining articles were available for screening.

Article selection

The abstracts

Search and selection

The described search yielded 1276 hits in Pubmed, 1586 in Embase and 29 in the Cochrane Library. After removing duplicates a total of 1597 articles remained for screening.

The first abstract screening left 302 articles for a more thorough screening, out of which 20 were deemed relevant. However, one study group did not describe how their model, named ‘a preliminary prognostic model’, was developed.²⁶ Of the remaining 19 articles, 17 were published in 1990 or later, of which two were excluded

Discussion

This review evaluated the currently available prognostic models for predicting outcome following resection of CRC liver metastases. All the included studies deal with prognostic models that are based on risk factors predicting outcome after resection for colorectal cancer liver metastases. Fifteen prognostic systems were identified and there was a tendency towards that the number of liver metastases, CRC spread to lymph nodes, maximum size of metastases, preoperative CEA level, extrahepatic

Conclusion

Currently there are several different prognostic models to predict survival or recurrence after liver resection for colorectal cancer metastases. However, the identified factors vary considerably between models and only few systems take into account that different factors have different levels of prognostic significance. Artificial neural networks have not yet been applied to predict outcome for this patient group and would be a potentially interesting step forward in the future creation of a

Conflict of interest statement

There are no conflicts of interest to be declared. No financial support was requested or received in the production of this article.

References (75)

G. Bengtsson et al.
Natural history of patients with untreated liver metastases from colorectal cancer
Am J Surg
(1981)
M.C. Tan et al.
A prognostic system applicable to patients with resectable liver metastasis from colorectal carcinoma staged by positron emission tomography with [18F]fluoro-2-deoxy-D-glucose: role of primary tumor variables
J Am Coll Surg
(2008)
S. Giacchetti et al.
Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery
Ann Oncol
(1999)
S. Iwatsuki et al.
Hepatic resection for metastatic colorectal adenocarcinoma: a proposal of a prognostic scoring system
J Am Coll Surg
(1999)
H.Z. Malik et al.
Prognostic influence of multiple hepatic metastases from colorectal cancer
Eur J Surg Oncol
(2007)
A. Sasaki et al.
Analysis of preoperative prognostic factors for long-term survival after hepatic resection of liver metastasis of colorectal carcinoma
J Gastrointest Surg
(2005)
D. Zorzi et al.
Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases
J Gastrointest Surg
(2006)
N. Kokudo et al.
Anatomical major resection versus nonanatomical limited resection for liver metastases from colorectal carcinoma
Am J Surg
(2001)
Z.Z. Hamady et al.
Resection margin in patients undergoing hepatectomy for colorectal liver metastasis: a critical appraisal of the 1cm rule
Eur J Surg Oncol
(2006)
R. Adam
The importance of visceral metastasectomy in colorectal cancer
Ann Oncol
(2000)

B. Nordlinger 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

Lancet

(2008)

P.J. Allen et al.

Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver metastases

J Gastrointest Surg

(2003)

S.S. Cross et al.

Introduction to neural networks

Lancet

(1995)

F.M. Selaru et al.

Artificial neural networks distinguish among subtypes of neoplastic colorectal lesions

Gastroenterology

(2002)

M.T. Keogan et al.

Outcome analysis of patients with acute pancreatitis by using an artificial neural network

Acad Radiol

(2002)

American Cancer Society

Global cancer facts and figures

(2007)

A. Jemal et al.

Cancer statistics

CA Cancer J Clin

(2010)

American Cancer Society

Cancer facts and figures

(2010)

J. Leporrier et al.

A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer

Br J Surg

(2006)

S. Bengmark et al.

The natural history of primary and secondary malignant tumors of the liver. I. The prognosis for patients with hepatic metastases from colonic and rectal carcinoma by laparotomy

Cancer

(1969)

M. Rees et al.

Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients

Ann Surg

(2008)

E.K. Abdalla et al.

Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases

Ann Surg

(2004)

F.G. Fernandez et al.

Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET)

Ann Surg

(2004)

D. Azoulay et al.

Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization

Ann Surg

(2000)

R. Adam et al.

Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors

Ann Surg

(2000)

R. Adam et al.

Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal

Ann Surg Oncol

(2001)

K. Ito et al.

Surgical treatment of hepatic colorectal metastasis: evolving role in the setting of improving systemic therapies and ablative treatments in the 21st century

Cancer J

(2010)

K. Okano et al.

Fibrous pseudocapsule of metastatic liver tumors from colorectal carcinoma. Clinicopathologic study of 152 first resection cases

Cancer

(2000)

J. Scheele et al.

Resection of colorectal liver metastases. What prognostic factors determine patient selection?

Chirurg

(2001)

M.A. Choti et al.

Trends in long-term survival following liver resection for hepatic colorectal metastases

Ann Surg

(2002)

A.C. Wei et al.

Survival after hepatic resection for colorectal metastases: a 10-year experience

Ann Surg Oncol

(2006)

M. Arru et al.

Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer

World J Surg

(2008)

Y. Fong et al.

Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases

Ann Surg

(1999)

B. Nordlinger et al.

Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie

Cancer

(1996)

M. Minagawa et al.

Simplified staging system for predicting the prognosis of patients with resectable liver metastasis: development and validation

Arch Surg

(2007)

S. Zakaria et al.

Hepatic resection for colorectal metastases: value for risk scoring systems?

Ann Surg

(2007)

Oxford Centre for Evidence-based Medicine Levels of Evidence

Cited by (114)

The management of colorectal liver metastases amenable of surgical resection: How to shape treatment strategies according to clinical, radiological, pathological and molecular features
2022, Cancer Treatment Reviews
Citation Excerpt :
Considering that most of patients experience disease relapse after resection of CRLM, several clinical, pathological and molecular factors were evaluated to estimate the prognosis of these patients and to better select candidates for curative surgery. A large series of prognostic scores were available, the most focused on patients eligible for upfront liver metastasectomy [51]. Among them, the Clinical Risk Score, published by Fong et al. in 1999, is still considered the milestone of risk stratification for patients with resectable CRLM [52].
Metastatic colorectal cancer (mCRC) patients have poor chances of long term survival, being < 15% of them still alive after 5 years from diagnosis. Nonetheless, patients with colorectal liver metastases (CRLM) may be eligible for metastases resection thus being able to achieve long-term disease remission and survival. The likelihood for patients with CRLM of being or becoming eligible for liver metastasectomy is increasing, thanks to the evolution of surgical techniques, the availability of active systemic treatments and the widespread diffusion of experienced multidisciplinary boards to manage these patients. However, disease relapse after liver surgery is common and occurs in two-thirds of resected patients. Therefore, adequate radiological staging and risk stratification is crucial for the optimal selection of patients candidate to surgery in order to maximize the benefit-risk ratio of liver metastasectomy and to individualize the treatment strategy. Based on the multidimensional assessment, three possible approaches are available: upfront liver surgery followed by adjuvant chemotherapy, perioperative chemotherapy preceding and following liver surgery, and an upfront systemic treatment including chemotherapy plus a targeted agent, both chosen according to patients’ and tumours’ characteristics, then followed by liver surgery if indicated. In this review, we describe the most important factors impacting the therapeutic choices in patients with resectable and potentially resectable CRLM, and we discuss the most promising factors that may reshape the future decision-making process of these patients.
Pre-operative imaging, response evaluation, and surgical planning – CT, PET, radiomics, and FLR measurement
2022, Contemporary Management of Metastatic Colorectal Cancer: A Precision Medicine Approach
Colorectal cancer (CRC) is one of the most common malignancies and a leading cause of cancer morbidity and mortality worldwide¹. Many factors can impact survival including the presence of metastases. The most common site of colorectal cancer metastases is the liver, as almost 20 percent of patients with CRC have liver metastasis at presentation². Among patients without liver metastases at presentation, about 25 percent will develop metachronous liver metastasis at some point in their disease course³. Different treatment options are available for patients with CRC and colorectal liver metastases (CRLM) including locoregional and systemic therapies³. Surgical resection remains, however, the best chance at long-term survival and cure^4,5. In this chapter, we aim to describe the different imaging modalities used to evaluate and stage patients with CRLM. We describe the role that each imaging modality plays and discuss the elements of hepatic imaging related to evaluation of response to preoperative therapy, as well as surgical planning.
mSEPT9 Can Monitor the Response and Predict the Prognosis of Stage IV colorectal cancer Patients with Liver Metastasis Undergoing Potentially Curative Surgery
2021, Journal of Surgical Research
Stage IV colorectal cancer (CRC) patients with liver metastasis undergoing potentially curative surgery represent a subgroup of patients with a relatively good prognosis. In this study, we aimed to evaluate the performance of mSEPT9 to monitor response to treatment and predict prognosis.
In total, we recruited 51 stage IV CRC patients with liver metastasis, including 20 patients who underwent simultaneous surgery and 31 patients who underwent staged surgery. We measured the blood levels of mSEPT9 and CEA prior to surgery and then seven days after surgery.
mSEPT9 and CEA were detected prior to surgery in 92.2% (47/51) and 70.6% (36/51) of patients, respectively. Following simultaneous and staged surgery, levels of mSEPT9 fell significantly by 923-fold (P<0.001) and 11-fold (P<0.001), respectively. Levels of CEA also fell significantly by 17-fold (P<0.001) and 1.7-fold (P<0.01) following simultaneous and staged surgery, respectively. The mean percentage reduction of mSEPT9 levels after simultaneous surgery (12.3%) was significantly lower than that of staged surgery (33.8%) (P<0.001) while the mean percentage reduction of CEA levels after simultaneous surgery (35.5%) were significantly lower than that of staged surgery (64.6%) (P<0.05). The levels of mSEPT9 in the blood were quantitatively correlated with tumor burden. Survival analysis showed that patients who tested negative for mSEPT9 pre- and post-surgery had a better survival rate than those who tested positive, thus suggesting that mSEPT9 can act as a prognostic indicator.
mSEPT9 showed good quantitative efficacy, higher applicability, and sensitivity, than CEA in assessing treatment response and prognosis prediction in patients with stage IV CRC and liver metastasis.
The Role of Definitive Radiation and Surgery in Metastatic Esophageal Cancer: An NCDB Investigation
2021, Annals of Thoracic Surgery
Approximately 40% of patients with esophageal cancer present with metastatic disease. Survival with palliative treatment is poor, and the benefit of aggressive focal therapies is unclear. This study aimed to identify a subset of patients with metastatic esophageal cancer with favorable outcomes after curative doses of radiation therapy, esophagectomy, or both.
Between 2004 and 2015, the study investigators found 28,101 patients with metastatic esophageal cancer in the National Cancer Database and identified those who underwent chemotherapy and definitive radiation therapy with or without surgery over the study period. The study compared the estimated median overall survival (OS) of all patients with metastatic esophageal cancer with the estimated median OS of patients with metastatic esophageal cancer who underwent radiation therapy with or without surgery. Multivariable analysis was used to examine clinical and pathologic factors associated with OS.
At a median follow-up of 11.1 months, 3219 patients with a median age of 64 years and a radiation dose of 50.4 Gy were identified. Only 202 (6.2%) patients undergoing definitive-dose radiation therapy underwent esophagectomy, with a median age of 60 years. The median OS durations for all patients, for patients treated with radiation, and for patients treated with radiation therapy in combination with esophagectomy were 6.6, 11.5, and 30.2 months, respectively. Among patients undergoing surgery, median OS after surgery was 23.7 months. Patients with lung, liver, or bone metastases were less likely to undergo esophagectomy. On multivariable analysis, esophagectomy and low tumor grade were associated with higher OS, whereas liver and bone metastases at diagnosis were associated with worse OS.
This analysis suggests that select subsets of patients with primarily nonvisceral, nonosseous metastatic esophageal cancer have favorable survival and may potentially benefit from aggressive local therapies.
Size of the Largest Colorectal Liver Metastasis Is an Independent Prognostic Factor in the Neoadjuvant Setting
2021, Journal of Surgical Research
Citation Excerpt :
Previously, several scoring systems have been developed to help predict long-term survival and are used as predictive analytical tools for patients with colorectal liver metastases (CRLM).4-6 Among the reported risk scores, pathologic size of the largest CRLM is often excluded as an independent risk factor,5-8 and those that included size of the largest CRLM based on radiology have previously reported 50mm-80 mm as prognostic discriminators.6-8 Recent advancements in surgical and perioperative treatment have continued to improve the survival of patients with CRLM.9-11
Up to 50% of patients diagnosed with colorectal cancer develop metastases during the course of their disease. Surgical resection remains the only curative treatment option for colorectal liver metastases (CRLM), frequently in conjunction with neoadjuvant chemotherapy. This study sought to determine if the pathologic size of the largest CRLM impacted disease-free survival (DFS) and disease-specific survival (DSS) in the setting of neoadjuvant chemotherapy.
All patients diagnosed with CRLM who underwent neoadjuvant chemotherapy for liver resection at the Massachusetts General Hospital between 2004 and 2016 were reviewed. The median size of the largest liver lesion was used as the cutoff for grouped evaluation.
A total of 214 patients were included. Median follow-up was 100.0 mo (interquartile range 68.9-133.8 mo). The median size of the largest lesion was 21 mm. Patients with lesions ≥21 mm exhibited significantly worse median DFS (12.5 mo versus 16.6 mo; P = 0.033) and median DSS (71.3 mo versus 103.5 mo; P = 0.038). CRLM lesions ≥21 mm were associated with poorer DFS on univariate analysis (hazard ratio (HR) = 1.42, 95% confidence interval (CI) 1.03-1.95 P = 0.033) and multivariable analysis (HR = 1.58, 95% CI 1.07-2.35, P = 0.023). CRLM lesions ≥21 mm were also independently associated with poorer DSS after liver resection on univariate analysis (HR = 1.51, 95% CI 1.02-2.24; P = 0.037) and multivariable analysis (HR = 1.98, 95% CI: 1.27-3.07; P = 0.002).
The size of the largest CRLM is an important prognostic factor for both DFS and DSS after neoadjuvant therapy and serves as a useful indicator of tumor biology.
The role of prostate-specific antigen in light of new scientific evidence: An update in 2020
2021, Actas Urologicas Espanolas
Revisar y actualizar las últimas evidencias científicas que se han producido en los últimos años con respecto al antígeno prostático específico (PSA) para su mejor aplicación en la práctica clínica habitual.
Análisis de la evidencia disponible acerca del papel actual del PSA, según la consideración de un panel de expertos que recoge su experiencia en el tema analizado.
Actualmente no puede considerarse el PSA únicamente un elemento orientativo en cuanto a la presencia o no de cáncer de próstata, sino que esta determinación ayuda al urólogo a indicar cuál es el tratamiento más conveniente ante un paciente con hipertrofia prostática benigna (HPB) como criterio de progresión de la enfermedad, así como a sospechar la existencia de un tumor prostático cuando la cifra de PSA se eleva > 0,3 ng/ml en pacientes bajo tratamiento con un inhibidor de la 5-alfa-reductasa sobre la cifra alcanzada a los 6 meses de haber iniciado dicho tratamiento. Sin embargo, los límites de este aumento del PSA con derivados de inhibidores de la 5-alfa-reductasa alternativos a la dutasterida están en controversia. Por otro lado, el PSA resulta clave para el seguimiento de pacientes tratados de un carcinoma prostático en cualquier estadio y con cualquier opción (cirugía, radioterapia o terapias focales u hormonoterapia), para definir recidiva bioquímica, sospechar la existencia de recidiva local o a distancia, así como para plantear o descartar tratamientos adyuvantes. Por último, recientemente se ha reforzado el papel del PSA como herramienta de cribado, demostrando unas tasas de aumento de mortalidad o de existencia de casos más agresivos de cáncer de próstata en aquellos países donde se ha disminuido el uso de esta herramienta.
Ofrecemos nuevos datos acerca del papel actual del PSA en el manejo de pacientes tratados por HPB y/o cáncer de próstata que deben tenerse en cuenta en la práctica clínica habitual, haciendo especial hincapié en el papel relevante de este biomarcador en el cribado y seguimiento del cáncer de próstata, así como en la progresión de la HPB en tratamiento con dutasterida.
To review and update the latest scientific evidence gathered in recent years regarding prostate-specific antigen (PSA) for better implementation into routine clinical practice.
Analysis of the available evidence on the current role of PSA, based on the experience of an expert panel in the subject under analysis.
Currently, PSA cannot be considered only as a guide for the presence or absence of prostate cancer. This determination can also help the urologist to decide on the most convenient treatment for a patient with benign prostatic hypertrophy (BPH) as a criterion for disease progression, and it can also suggest the suspicious existence of a prostatic tumor when there is PSA rise of >0.3 ng/ml over the level reached 6 months after having initiated treatment with 5-alpha-reductase inhibitor. However, the limits of this PSA rise with derivatives of alternative 5-alpha-reductase (5-ARI) inhibitors to dutasteride are controversial. Moreover, PSA is a key factor for the follow-up of patients with prostate adenocarcinoma at any stage who have received treatment (surgery, radiotherapy or focal therapies, hormone therapy), it acts as a guide to identify biochemical recurrence, to suspect the existence of local or distant recurrence, as well as to propose or discard adjuvant treatments. Finally, the role of PSA as a screening tool has been recently reinforced, demonstrating increased mortality rates or the existence of more aggressive cases of prostate cancer in those countries where the use of this tool has declined.
We present new data about the current role of PSA in the management of patients treated for BPH and/or prostate cancer that should be implemented into routine clinical practice, with special emphasis on the relevant role of this biomarker in the screening and follow-up of prostate cancer, as well as in the progression of BPH in dutasteride treatment.

View all citing articles on Scopus

View full text

ReviewPrognostic models for outcome following liver resection for colorectal cancer metastases: A systematic review

Abstract

Background

Aims

Methods

Results

Conclusion

Introduction

Section snippets

Search strategy

Article selection

Search and selection

Discussion

Conclusion

Conflict of interest statement

Am J Surg

J Am Coll Surg

Ann Oncol

J Am Coll Surg

Eur J Surg Oncol

J Gastrointest Surg

J Gastrointest Surg

Am J Surg

Eur J Surg Oncol

Ann Oncol

Lancet

J Gastrointest Surg

Lancet

Gastroenterology

Acad Radiol

Global cancer facts and figures

Cancer statistics

CA Cancer J Clin

Cancer facts and figures

A population-based study of the incidence, management and prognosis of hepatic metastases from colorectal cancer

Br J Surg

The natural history of primary and secondary malignant tumors of the liver. I. The prognosis for patients with hepatic metastases from colonic and rectal carcinoma by laparotomy

Cancer

Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients

Ann Surg

Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases

Ann Surg

Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET)

Ann Surg

Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization

Ann Surg

Two-stage hepatectomy: a planned strategy to treat irresectable liver tumors

Ann Surg

Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal

Ann Surg Oncol

Surgical treatment of hepatic colorectal metastasis: evolving role in the setting of improving systemic therapies and ablative treatments in the 21st century

Cancer J

Fibrous pseudocapsule of metastatic liver tumors from colorectal carcinoma. Clinicopathologic study of 152 first resection cases

Cancer

Resection of colorectal liver metastases. What prognostic factors determine patient selection?

Chirurg

Trends in long-term survival following liver resection for hepatic colorectal metastases

Ann Surg

Survival after hepatic resection for colorectal metastases: a 10-year experience

Ann Surg Oncol

Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer

World J Surg

Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases

Ann Surg

Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie

Cancer

Simplified staging system for predicting the prognosis of patients with resectable liver metastasis: development and validation

Arch Surg

Hepatic resection for colorectal metastases: value for risk scoring systems?

Ann Surg

Review
Prognostic models for outcome following liver resection for colorectal cancer metastases: A systematic review