Value of prognostic scoring systems in the era of multimodal therapy for recurrent colorectal liver metastases

Background: Various predictive scoring systems have been developed to estimate outcomes of pa-tients undergoing surgery for colorectal liver metastases (CRLM). However, data regarding their effec-tiveness in recurrent CRLM (recCRLM) are very limited. Methods: Patients who underwent repeat hepatectomy for recCRLM at the University Hospital RWTH Aachen, Germany from 2010 to 2021 were included. Nine predictive scoring systems (Fong's, Nordlinger, Nagashima, RAS mutation, Tumor Burden, GAME, CERR, and Glasgow Prognostic score, Basingstoke Index) were evaluated by likelihood ratio (LR) x2, linear trend (LT) x2 and Akaike Information Criterion (AIC) for their predictive value regarding overall survival (OS) and recurrence free survival (RFS). Results: Among 150 patients, median RFS was 9 (2-124) months with a 5-year RFS rate of 10%. Median OS was 39 (4-131) months with a 5-year OS rate of 32%. For RFS and OS, the Nagashima score showed the best prognostic ability (LT x2 3.00, LR x2 9.39, AIC 266.66 and LT x2 2.91, LR x2 20.91, 290.36). Discussion: The Nagashima score showed the best prognostic stratification to predict recurrence as well as survival, and therefore might be considered when evaluating patients with recCRLM for repeat hepatectomy.