Enhancing outcome prediction in patients with colorectal liver metastases undergoing hepatectomy: the synergistic impact of FIB-4 index and tumor burden score across KRAS profiles

被引：1
作者：
Akabane, Miho [1 ,2 ]
Kawashima, Jun [1 ,2 ]
Woldesenbetm, Selamawit [1 ,2 ]
Macedo, Amanda B. [1 ,2 ]
Altaf, Abdullah [1 ,2 ]
Aucejo, Federico [3 ]
Popescu, Irinel [4 ]
Kitago, Minoru [5 ]
Poultsides, George A. [6 ]
Sasaki, Kazunari [6 ]
Imaoka, Yuki [6 ]
Ruzzenente, Andrea [7 ]
Endo, Itaru [8 ]
Pawlik, Timothy M. [1 ,2 ]
机构：
[1] Ohio State Univ, Wexner Med Ctr, Dept Surg, Columbus, OH USA
[2] James Comprehens Canc Ctr, Columbus, OH USA
[3] Cleveland Clin Fdn, Dept Gen Surg, Cleveland, OH USA
[4] Fundeni Clin Inst, Dept Surg, Bucharest, Romania
[5] Keio Univ, Dept Surg, Tokyo, Japan
[6] Stanford Univ, Dept Surg, Stanford, CA USA
[7] Univ Verona, Dept Surg, Verona, Italy
[8] Yokohama City Univ, Sch Med, Dept Gastroenterol Surg, Yokohama, Japan
来源：
HPB | 2025年 / 27卷 / 07期
关键词：
LONG-TERM OUTCOMES; HEPATIC RESECTION; CURATIVE RESECTION; FIBROSIS SCORE; MUTATION; CANCER; RECURRENCE; BIOMARKERS; CRITERIA; DISEASE;
D O I：
10.1016/j.hpb.2025.04.002
中图分类号：
R57 [消化系及腹部疾病];
学科分类号：
摘要：
Background: The prognostic value of Fibrosis-4 (FIB-4) index, concerning KRAS status (wild-type [wtKRAS] vs. mutated [mutKRAS]) remains unclear in post-hepatectomy colorectal liver metastases (CRLM). We evaluated the combined impact of FIB-4 and Tumor Burden Score (TBS) on overall survival (OS)/recurrence-free survival (RFS), stratified by KRAS status. Methods: CRLM patients undergoing hepatectomy (2000-2020) were analyzed, grouped by TBS/FIB-4. Results: Among 828 patients, 196 had high FIB-4. High TBS had worse 5-year OS (P < 0.001). In wtKRAS, high TBS correlated with worse OS (P < 0.001), but not in mutKRAS. High FIB-4 correlated with worse OS (P = 0.01). Sub-stratification showed no OS difference by FIB-4 in wtKRAS, but a difference in mutKRAS (P = 0.03). Multivariable analysis identified mutKRAS (HR: 1.90), high TBS (HR: 1.62), and FIB-4 (HR: 1.15) as mortality risk factors. The TBS-FIB-4-KRAS index had highest predictive accuracy. For RFS, TBS and FIB-4 independently stratified outcomes. High TBS was associated with worse RFS in wtKRAS (P < 0.001) but not in mutKRAS. High FIB-4 decreased RFS in mutKRAS (P = 0.001) but not in wtKRAS. FIB-4 was associated with a 10% increased recurrence risk. Conclusion: TBS and FIB-4, alongside KRAS status, should be considered to improve outcome predictions.
引用
收藏
页码：961 / 970
页数：10
相关论文
共 47 条
[1]   Complex non-invasive fibrosis models are more accurate than simple models in non-alcoholic fatty liver disease [J].
Adams, Leon A. ;
George, Jacob ;
Bugianesi, Elisabetta ;
Rossi, Enrico ;
De Boer, W. Bastiaan ;
van der Poorten, David ;
Ching, Helena L. I. ;
Bulsara, Max ;
Jeffrey, Gary P. .
JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 2011, 26 (10) :1536-1543
[2]   Fibrosis-4 Index, a Noninvasive Fibrosis Marker, Predicts Survival Outcomes After Hepatectomy for Colorectal Cancer Liver Metastases [J].
Akiyama, Takahiko ;
Miyamoto, Yuji ;
Imai, Katsunori ;
Yamashita, Yoichi ;
Nomoto, Daichi ;
Daitoku, Nobuya ;
Sakamoto, Yuki ;
Kiyozumi, Yuki ;
Tokunaga, Ryuma ;
Eto, Kojiro ;
Harada, Kazuto ;
Hiyoshi, Yukiharu ;
Iwatsuki, Masaaki ;
Nagai, Yohei ;
Iwagami, Shiro ;
Baba, Yoshifumi ;
Yoshida, Naoya ;
Baba, Hideo .
ANNALS OF SURGICAL ONCOLOGY, 2020, 27 (09) :3534-3541
[3]   The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging [J].
Amin, Mahul B. ;
Greene, Frederick L. ;
Edge, Stephen B. ;
Compton, Carolyn C. ;
Gershenwald, Jeffrey E. ;
Brookland, Robert K. ;
Meyer, Laura ;
Gress, Donna M. ;
Byrd, David R. ;
Winchester, David P. .
CA-A CANCER JOURNAL FOR CLINICIANS, 2017, 67 (02) :93-99
[4]   Molecular pathogenesis of intrahepatic cholangiocarcinoma [J].
Andersen, Jesper B. .
JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES, 2015, 22 (02) :101-113
[5]   The NAFLD fibrosis score: A noninvasive system that identifies liver fibrosis in patients with NAFLD [J].
Angulo, Paul ;
Hui, Jason M. ;
Marchesini, Giulio ;
Bugianesi, Ellisabetta ;
George, Jacob ;
Farrell, Geoffrey C. ;
Enders, Felicity ;
Saksena, Sushma ;
Burt, Alastair D. ;
Bida, John P. ;
Lindor, Keith ;
Sanderson, Schuyler O. ;
Lenzi, Marco ;
Adams, Leon A. ;
Kench, James ;
Therneau, Terry M. ;
Day, Christopher P. .
HEPATOLOGY, 2007, 45 (04) :846-854
[6]   Non-invasive Diagnosis of Fibrosis in Non-alcoholic Fatty Liver Disease [J].
Arora, Anil ;
Sharma, Praveen .
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY, 2012, 2 (02) :145-155
[7]   Colorectal Liver Metastasis: Can Cytokines Make the Difference? [J].
Ballaro, Costanza ;
Quaranta, Valeria ;
Giannelli, Gianluigi .
CANCERS, 2023, 15 (22)
[8]   Underlying liver disease, not tumor factors, predicts long-term survival alter resection of hepatocellular carcinoma [J].
Bilimoria, MM ;
Lauwers, GY ;
Doherty, DA ;
Nagorncy, DM ;
Belghiti, J ;
Do, KA ;
Regimbeau, JM ;
Ellis, LM ;
Curley, SA ;
Ikai, I ;
Yamaoka, Y ;
Vauthey, JN .
ARCHIVES OF SURGERY, 2001, 136 (05) :528-534
[9]   RAS Mutation Clinical Risk Score to Predict Survival After Resection of Colorectal Liver Metastases [J].
Brudvik, Kristoffer W. ;
Jones, Robert P. ;
Giuliante, Felice ;
Shindoh, Junichi ;
Passot, Guillaume ;
Chung, Michael H. ;
Song, Juhee ;
Li, Liang ;
Dagenborg, Vegar J. ;
Fretland, Asmund A. ;
Rosok, Bard ;
De Rose, Agostino M. ;
Ardito, Francesco ;
Edwin, Bjorn ;
Panettieri, Elena ;
Larocca, Luigi M. ;
Yamashita, Suguru ;
Conrad, Claudius ;
Aloia, Thomas A. ;
Poston, Graeme J. ;
Bjornbeth, Bjorn A. ;
Vauthey, Jean-Nicolas .
ANNALS OF SURGERY, 2019, 269 (01) :120-126
[10]   Correlation between FIB4, liver stiffness and metabolic parameters in patients with HIV and hepatitis C virus co-infection [J].
Bruno, Raffaele ;
Sacchi, Paolo ;
Cima, Serena ;
Maiocchi, Laura ;
Patruno, Savino F. A. ;
Klersy, Catherine ;
Barbarini, Giorgio ;
Zuccaro, Valentina ;
Camma, Calogero ;
Filice, Gaetano .
DIGESTIVE AND LIVER DISEASE, 2011, 43 (07) :575-578
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