Nomogram Incorporating Preoperative Testing Markers for the prediction of Early Recurrence for Colorectal Liver Metastases with Neoadjuvant Chemotherapy followed by Hepatectomy

Background: This study aims to develop a nomogram to predict early recurrence in colorectal liver metastases (CRLM) patients who received neoadjuvant chemotherapy (NAC) followed by hepatectomy. Methods: The primary cohort included 144 CRLM patients treated in the same ward, and 40 CRLM patients from another ward were allocated to the validation cohort. The minimum p value method was used to find the optimal cut-off point for early recurrence. Predictors of early recurrence were determined by univariate analysis and multivariate logistic regression. Nomogram for early recurrence was constructed and area under the receiver operating characteristic curve (AUROC), calibration curves, and decision curve analysis (DCA) were used to evaluate its performance. Results: The optimal cut-off point for the definition of early recurrence was 11 months. Patients with early recurrence have significantly worse post-recurrence survival (median 23.5 months vs. 35.7 months, P=0.012) and overall survival (median 31.8 months vs. 59.0 months, P<0.001). Preoperative creatinine ≥ 63.5 µmol/L (P=0.035), synchronous liver metastasis (P=0.030), non-R0 resection (P=0.044), postoperative complications (P=0.009) and NAC Cycles ≥ 4 (P=0.003) were independent predictors of early recurrence. A nomogram with favorable discrimination (AUROC of 0.754 in the primary cohort and 0.882 in the validation cohort) and calibration was constructed to predict early recurrence. The DCA results also indicated good clinical applicability. Conclusions: This is the first study to identify elevated preoperative creatinine as an independent predictor of early recurrence of CRLM treated with hepatectomy after NAC. This study developed a nomogram that particularly incorporated preoperative creatinine to predict early recurrence in CRLM patients receiving NAC to aid clinical decision-making.