Background: Preoperative chemotherapy is increasingly used for colorectal liver metastases (CRLM), but simple risk stratification tools for routine practice remain limited. We developed a simple risk model to predict outcomes after curative-intent CRLM resection, including in patients receiving preoperative chemotherapy.Methods: We retrospectively analyzed 115 patients who underwent initial curative-intent liver resection for CRLM at two centers. Factors associated with recurrence-free survival (RFS) and overall survival (OS) were evaluated using Cox proportional hazards models and log-rank tests. Model performance was benchmarked against the Beppu nomogram and Fong’s clinical risk score using the area under the curve (AUC). Outcomes were also assessed based on response to preoperative chemotherapy.Results: Having ≥3 CRLMs was the only independent predictor common to both OS and RFS. Among patients with 1–2 CRLMs, the largest tumor diameter being ≥5 cm independently predicted RFS. A composite high-risk definition (≥3 CRLMs, or 1–2 CRLMs with a diameter ≥ 5 cm) independently predicted recurrence (HR 2.05,p= 0.007) and overall mortality (HR 2.24,p= 0.017). The AUCs were similar to the Beppu nomogram for recurrence (0.68 vs. 0.70 (p= 0.683) at 36 months, 0.66 vs. 0.68 (p= 0.766) at 60 months) and to Fong’s score for survival (0.59 vs. 0.64 (p= 0.430) at 36 months, 0.65 vs. 0.74 (p= 0.074) at 60 months). Among patients receiving preoperative chemotherapy (n= 72), high-risk status was associated with poorer RFS (HR 3.11,p< 0.001) and OS (HR 2.80,p= 0.010). Within this subgroup, progressive disease (PD) was associated with worse outcomes than disease control (CR/PR/SD).Conclusions: This two-variable, rule-based model provides an easy-to-use tool for postoperative risk stratification after CRLM resection, and incorporating chemotherapy response may further refine prognostication.
背景：术前化疗在结直肠癌肝转移（CRLM）中的应用日益增多，但适用于常规临床实践的简易风险分层工具仍然有限。本研究开发了一个简易风险模型，旨在预测根治性CRLM切除术后的预后，包括接受术前化疗的患者。方法：我们回顾性分析了两个中心115例首次接受根治性肝切除术的CRLM患者。采用Cox比例风险模型和时序检验评估与无复发生存期（RFS）和总生存期（OS）相关的因素，并以曲线下面积（AUC）为指标，将模型性能与Beppu列线图和Fong临床风险评分进行对比。同时根据对术前化疗的反应评估预后。结果：肝转移灶数量≥3个是OS和RFS共有的唯一独立预测因子。在1-2个肝转移灶的患者中，最大肿瘤直径≥5 cm是RFS的独立预测因子。综合高风险定义（肝转移灶≥3个，或1-2个转移灶且直径≥5 cm）可独立预测复发（HR 2.05, p=0.007）和总死亡率（HR 2.24, p=0.017）。该模型在预测复发方面的AUC与Beppu列线图相近（36个月：0.68 vs. 0.70 (p=0.683)；60个月：0.66 vs. 0.68 (p=0.766)），在预测生存方面与Fong评分相近（36个月：0.59 vs. 0.64 (p=0.430)；60个月：0.65 vs. 0.74 (p=0.074)）。在接受术前化疗的患者（n=72）中，高风险状态与较差的RFS（HR 3.11, p<0.001）和OS（HR 2.80, p=0.010）相关。在该亚组中，疾病进展（PD）患者的预后较疾病控制（完全缓解/部分缓解/疾病稳定）者更差。结论：这个基于两个变量、规则明确的模型为CRLM切除术后的风险分层提供了一个易于使用的工具，结合化疗反应可能进一步优化预后评估。
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