Genetic And Morphological Evaluation (GAME) score for patients with colorectal liver metastases

• DOI: 10.1002/bjs.10838
• Publication Date: 2018-04-25T08:37:44Z
• Authors: G A Margonis; K Sasaki; S Gholami; Y Kim; N Andreatos; N Rezaee; A Deshwar; S Buettner; P J Allen; T P Kingham; T M Pawlik; J He; J L Cameron; W R Jarnagin; C L Wolfgang; M I D'Angelica; M J Weiss
• Keywords: Male; EMC OR-01; DNA Mutational Analysis; Proto-Oncogene Proteins p21(ras); 03 medical and health sciences; 0302 clinical medicine; Biomarkers, Tumor; Hepatectomy; Humans; Aged; Retrospective Studies; Liver Neoplasms; DNA, Neoplasm; Middle Aged; Prognosis; Carcinoembryonic Antigen; Tumor Burden; 3. Good health; Liver; ROC Curve; Mutation; Female; Colorectal Neoplasms; Follow-Up Studies

Abstract Background This study sought to develop a clinical risk score for resectable colorectal liver metastasis (CRLM) by combining clinicopathological and clinically available biological indicators, including KRAS. Methods A cohort of patients who underwent resection CRLM at the Johns Hopkins Hospital (JHH) was analysed identify independent predictors overall survival (OS) that can be assessed before operation; these factors were combined into Genetic And Morphological Evaluation (GAME) score. The compared with current standard (Fong score) validated in an external from Memorial Sloan Kettering Cancer Center (MSKCC). Results Six preoperative worse OS identified on multivariable Cox regression analysis JHH (502 patients). GAME calculated allocating points each patient according presence predictive factors: KRAS-mutated tumours (1 point); carcinoembryonic antigen level 20 ng/ml or more point), primary tumour lymph node Tumour Burden Score between 3 8 point) 9 over (2 points); extrahepatic disease points). high-risk group (GAME least 4 points) had 5-year rate 11 per cent, 73·4 cent those low-risk (score 0–1 point). Importantly, cohorts both MSKCC (747 patients), discriminatory capacity superior Fong score, as demonstrated C-index Akaike information criterion. Conclusion is prognostic tool used inform treatment selection.