The clinical risk score: emerging as a reliable preoperative prognostic index in hepatectomy for colorectal metastases

Abstract

Hypothesis: The purpose of this study was to examine the validity of the clinical risk score (CRS), a prognostic tool developed by Fong et al, when translated to another center. Design: This study assesses 5 independent preoperative prognostic criteria, nodal status of the primary lesion, disease-free interval, number of hepatic metastases, size of the largest metastasis, and preoperative carcinoembryonic antigen level, to determine a preoperative CRS for each patient included in the study. Setting: The hepatobiliary unit of The Queen Elizabeth Hospital, Adelaide, South Australia. Patients: Medical records of patients admitted to The Queen Elizabeth Hospital undergoing potentially curative hepatic resection for colorectal metastases during the period of July 1993 to April 2003 were included in the study. Main Outcome Measure: The primary outcome measure of the study was survival. The calculated CRS was analyzed with respect to patient postoperativesurvival. Results: During the 10-year period, 77 patients underwent hepatic resection. Overall survival rates for 1, 3, and 5 years were found to be 80.9%, 57.5%, and 42.3%, respectively. One- and 5-year survival rates for CRSs of 0 and 1 were found to be 93.8% and 72.5%, respectively; for scores of 2 and 3, 76.6% and 31.2%, respectively;and for scores of 4 and 5, 75% and 0%, respectively. No patient with a CRS greater than 3 survived more than2 years. Conclusion: This study validates the CRS, finding it to be highly predictive of patient outcome and survival.