Survival prediction of colorectal liver metastases underwent surgical resection after neoadjuvant chemotherapy: Tumor response combined with the genetic and morphological evaluation score

Abstract

Introduction

Neoadjuvant chemotherapy is becoming routine for colorectal liver metastasis (CRLM) in patients with high risks of recurrence or in whom resection is difficult. This retrospective study aimed to establish a modified survival prediction model for patients with CRLM who underwent hepatectomy after neoadjuvant chemotherapy.

Materials and methods

A total of 619 patients who received neoadjuvant chemotherapy followed by hepatectomy between 2006 and 2021 were included and divided into training and validation groups at a ratio of 2:1. The model was established in training group and validated in validation group. Chemotherapy response was integrated into the genetic and morphological evaluation (GAME) score as a new NeoGAME model, with assigned points based on the hazard ratio in the multivariate Cox regression. The NeoGAME score grouping cutoff was divided using X-tile, and the predictive power was compared with that of traditional models.

Results

The 5-year overall survival were significantly different in the NeoGAME low-risk (0–2 points), medium-risk (3–4 points) and high-risk (≥5 points) groups (training group, P < 0.001; validation group, P = 0.0012). The area under the curve in predicting 5-year survival was 0.67 and 0.66 for the training and validation groups, respectively. Time-dependent receiver operating characteristic curve showed better discrimination ability of NeoGAME than the GAME score in predicting 5-year survival.

Conclusions

The newly established NeoGAME score can predict survival more precisely for patients with CRLM receiving neoadjuvant chemotherapy. Moreover, the model offers a useful tool for assessing tumor behavior and selecting a benefiting population for liver resection.