دورية أكاديمية
Prognostic Factors Change Over Time After Hepatectomy for Colorectal Liver Metastases: A Multi-institutional, International Analysis of 1099 Patients.
| العنوان: | Prognostic Factors Change Over Time After Hepatectomy for Colorectal Liver Metastases: A Multi-institutional, International Analysis of 1099 Patients. |
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| المؤلفون: | Margonis GA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Buettner S; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Andreatos N; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Wagner D; Department of General Surgery, Medical University of Graz, Graz, Austria., Sasaki K; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH., Barbon C; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Beer A; Department of General Surgery, Medical University of Vienna, Vienna, Austria., Kamphues C; Department of General, Visceral and Vascular Surgery, Charite Campus Benjamin Franklin, Berlin, Germany., Løes IM; Department of Clinical Science, University of Bergen, Bergen, Norway.; Department of Oncology, Haukeland University Hospital, Bergen, Norway., He J; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Pawlik TM; Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH., Kaczirek K; Department of General Surgery, Medical University of Vienna, Vienna, Austria., Poultsides G; Department of Surgery, Stanford University School of Medicine, Stanford, CA., Lønning PE; Department of Clinical Science, University of Bergen, Bergen, Norway.; Department of Oncology, Haukeland University Hospital, Bergen, Norway., Cameron JL; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Mischinger HJ; Department of General Surgery, Medical University of Graz, Graz, Austria., Aucejo FN; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH., Kreis ME; Department of General, Visceral and Vascular Surgery, Charite Campus Benjamin Franklin, Berlin, Germany., Wolfgang CL; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Weiss MJ; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. |
| المصدر: | Annals of surgery [Ann Surg] 2019 Jun; Vol. 269 (6), pp. 1129-1137. |
| نوع المنشور: | Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0372354 Publication Model: Print Cited Medium: Internet ISSN: 1528-1140 (Electronic) Linking ISSN: 00034932 NLM ISO Abbreviation: Ann Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Philadelphia, PA : Lippincott Williams & Wilkins |
| مواضيع طبية MeSH: | Hepatectomy*, Colorectal Neoplasms/*pathology , Liver Neoplasms/*secondary , Liver Neoplasms/*surgery, Aged ; Colorectal Neoplasms/genetics ; Colorectal Neoplasms/mortality ; Europe ; Female ; Humans ; Liver Neoplasms/mortality ; Male ; Middle Aged ; Mutation/genetics ; Prognosis ; Proto-Oncogene Proteins B-raf/genetics ; Proto-Oncogene Proteins p21(ras)/genetics ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Survival Rate ; Time Factors ; United States |
| مستخلص: | Objective: To evaluate the changing impact of genetic and clinicopathologic factors on conditional overall survival (CS) over time in patients with resectable colorectal liver metastasis. Background: CS estimates account for the changing likelihood of survival over time and may reveal the changing impact of prognostic factors as time accrues from the date of surgery. Methods: CS analysis was performed in 1099 patients of an international, multi-institutional cohort. Three-year CS (CS3) estimates at the "xth" year after surgery were calculated as follows: CS3 = CS (x + 3)/CS (x). The standardized difference (d) between CS3 rates was used to estimate the changing prognostic power of selected variables over time. A d < 0.1 indicated very small differences between groups, 0.1 ≤ d < 0.3 indicated small differences, 0.3 ≤ d < 0.5 indicated moderate differences, and d ≥ 0.5 indicated strong differences. Results: According to OS estimates calculated at the time of surgery, the presence of BRAF and KRAS mutations, R1 margin status, resected extrahepatic disease, patient age, primary tumor lymph node metastasis, tumor number, and carcinoembryonic antigen levels independently predicted worse survival. However, when temporal changes in the prognostic impact of these variables were considered using CS3 estimates, BRAF mutation dominated prognosis during the first year (d = 0.48), whereas surgeon-related variables (ie, surgical margin and resected extrahepatic disease) determined prognosis thereafter (d ≥ 0.5). Traditional clinicopathologic factors affected survival constantly, but only to a moderate degree (0.3 ≤ d < 0.5). Conclusions: The impact of genetic, surgery-related, and clinicopathologic factors on OS and CS3 changed dramatically over time. Specifically, BRAF mutation status dominated prognosis in the first year, whereas positive surgical margins and resected extrahepatic disease determined prognosis thereafter. |
| المشرفين على المادة: | 0 (KRAS protein, human) EC 2.7.11.1 (BRAF protein, human) EC 2.7.11.1 (Proto-Oncogene Proteins B-raf) EC 3.6.5.2 (Proto-Oncogene Proteins p21(ras)) |
| تواريخ الأحداث: | Date Created: 20190515 Date Completed: 20200116 Latest Revision: 20200511 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1097/SLA.0000000000002664 |
| PMID: | 31082912 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1528-1140 |
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| DOI: | 10.1097/SLA.0000000000002664 |