Liver metastases from colorectal carcinoma: performance of pathological response scores

Abstract

Background: Pathological response of liver metastases (LM) from colorectal carcinoma (CRC) to neoadjuvant therapy is one of the prognostic factors correlated with recurrence and survival. The aim of this study was to compare the performance of two prognostic scores in patients operated for colorectal cancer liver metastases (CRCLM). Methods: A study was performed of patients who underwent preoperative chemotherapy (CT), followed by resection of LM, from 2015-2021. Pathological response was evaluated according to Rubbia-Brandt tumor regression grade (TRG) and the Blazer scoring system. Then, we studied the performance of these two prognostic scores, based on homogeneity using the likelihood Ratio (LR+), monotonicity and discriminative ability using the area under the receiver operating characteristic (ROC) curve (AUC). Results: 70 cases were included in the study. Mean age was 56 years. The sex ratio was 2.2. Forty patients were stage IV (57%) with synchronous all CRCLMs. The overall survival, all stages combined, was 85.5% at 12 months, 41.7% at 24 months and 19.3% at 36 months. The mean survival was better in case of major response (TRG1/TRG2) evaluated at 40.1 and 41.1 months after diagnosis. In cases of partial response (TRG3), the mean survival was 32.1 months. In cases with no response (TRG4/TRG5), survival was estimated at 29.9 and 18.5 months. The Rubbia-Brandt TRG had the highest LR+ (10.95). The LR+ of the Rubbia-Brandt score was greater than 10, so it was a test with very strong contribution. The LR+ of the Blazer score was between 5 and 10, it was a test with strong contribution. The Rubbia-Brandt TRG had the highest linearity value (10.73). With a higher AUC of the ROC curve (0.8), the Rubbia-Brandt TRG was better at predicting survival than the Blazer score.