The impact of tumor burden score on postoperative morbidity and survival in colorectal cancer patients with liver metastases
Burlaka A.1, Bezverhnyi V.1, Mykytyuk A.1, Dupyk M.1, Zvirych V.1, Shudrak A.1, Zemskov S.2, Skyba V.2
- 1Nonprofit Organization National Cancer Institute, Kyiv, Ukraine
- 2Bogomolets National Medical University, Kyiv, Ukraine
Summary. Introduction. Surgical oncologists are increasingly interested in how to make the transition from technically to biologically guided surgery for colorectal cancer with liver metastases (mCRC). Taking into account the tumor burden score (TBS) has demonstrated its effectiveness and accuracy in predicting the risk of cancer-specific death in a number of studies. Objective. To determine the possible correlations between the TBS, oncological prognosis and postoperative complications of patients with mCRC in the Ukrainian population. Materials and methods. A retrospective analysis of patients with mCRC who underwent liver resection in the period from September 2002 to March 2024 at the clinic of the National Cancer Institute was performed. The selected cohort included 351 patients with synchronous and metachronous metastatic liver disease (cT1–4N0–2M0–1). The tumor burden index was used as a combined indicator of the TBS, taking into account the maximum size of the metastasis and the number of foci was calculated according to the Sasaki et al. Metro-ticket mathematic model. Results. The median number of metastatic lesions was 5 (1–23), and the mean size of the targeted largest metastatic lesion diameter was 35±1.6 cm. The mean value of the TBS was 7±0.14. Based on the clustering data, overall survival (OS) was calculated in the cohorts with TBS <3.5; 3.5–10 and >10, respectively. The median and 5-year OS in these cohorts were 69.5; 60.3 and 23.1 months, and 56.3; 49.7 and 7.4%, respectively (p <0.001). The ability of the TBS to predict postoperative complications was analyzed using the ROC curve, which demonstrated high sensitivity with AUC=0.822. According to multivariate Cox analysis, TBS clusters had a significant negative impact on OS, in particular, cohorts with TBS 3.5–10 (Hazard ratio (HR) = 0.43; 95% CI 0.18–0.97, p=0.04) and TBS ≥10 (HR=1.4; 95% confidence interval (CI) 1.31–1.46, p=0.005). Conclusions. This study demonstrated that the TBS can be applied to patients to national population-based cohort of colorectal cancer patients with liver metastases. The TBS has a strong prognostic potential for OS and surgical complications.
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