Clinico‐metabolic characterization improves the prognostic value of histological growth patterns in patients undergoing surgery for colorectal liver metastases

BACKGROUND AND OBJECTIVES: The histological growth pattern (HGP) represents a strong prognostic factor in patients undergoing surgery for colorectal liver metastases (CRLM). We evaluated whether the combination of HGP with clinico‐metabolic parameters could improve its prognostic value. METHODS: In a series of 108 patients undergoing resection of CRLM, the HGP of CRLM was scored according to international guidelines. Baseline clinico‐metabolic clinical status was evaluated using a metabolic‐Clinical Risk Score (mCRS), combining traditional Memorial Sloan Kettering‐CRS parameters with the tumor‐to‐liver glucose uptake ratio as measured with (18)Fluorodeoxyglucose/positron emission tomography. RESULTS: In patients with desmoplastic HGP (DHGP) CRLM (20% of all patients), 5‐ and 10‐years overall survival (OS) and disease free survival (DFS) were 66% and 43% and 37% and 24.5%, as compared with 35% and 21% and 11% and 11% in the non‐DHGP group (p = 0.07 and 0.054). Among DHGP patients, those with a low‐risk mCRS had improved postoperative outcomes, 5‐ and 10‐years OS and DFS reaching 83.3% and 62.5% and 50% and 33%, as compared with 18% and 0% and 0% and 0% in high‐risk mCRS patients (p = 0.007 and 0.003). In contrast, mCRS did not influence postoperative survivals in non‐DHGP patients. CONCLUSIONS: Combining the clinico‐metabolic characteristics with the HGP may improve prognostication in patients undergoing surgery for CRLM.