Preoperative Prognostic Score for Patients With Colorectal Liver Metastases
Posted: Thursday, June 21, 2018
Georgios Antonios Margonis, MD, PhD, of Johns Hopkins University School of Medicine, and colleagues have developed a clinical risk score for patients with resectable colorectal liver metastasis called the Genetic And Morphological Evaluation (GAME) score. According to their study findings, which were published in the British Journal of Surgery, this score seemed to outperform the previous standard, the Fong score.
Detailed preoperative information was extracted from records of 502 patients who underwent complete resection of colorectal liver metastasis. Predictive factors included in the GAME score were KRAS mutation status (1 point), carcinoembryonic antigen level of 20 ng/mL or more (1 point), primary tumor lymph node metastasis (1 point), and extrahepatic disease (2 points). The researchers determined the prognostic cutoff levels based on the Tumor Burden Score, which accounts for both the size and number of tumors. They separated patients into TBS below 3 (0 points), between 3 and 8 (1 point), and 9 or above (2 points).
According to the authors, “GAME is the first clinical risk score to incorporate clinically available genetic information (KRAS status).”
Patients were assigned to groups of low risk (GAME score 0–1), medium risk (GAME score 2–3), and high risk (GAME score 4 or more). The overall survival of patients stratified into groups based on GAME and Fong scores was followed both in the original cohort and in another cohort of 747 patients. The Fong score is based on the number and size of metastases as well as the disease-free interval, carcinoembryonic antigen level, and node-positive primary tumor, with lower scores suggesting lower risk.
In the original cohort, although the patients rated low risk on the Fong Score had a higher 5-year overall survival than those rated high risk, no significant difference was detected between those rated medium and high risk. For the GAME score, patients rated low risk had a significantly higher 5-year overall survival rate than those rated high risk (73.4% for low-risk group vs. 11% for high-risk group in original cohort).