599P - A validation of current prognostic scores in metastatic colorectal cancer (mCRC) and a new prognostic score (A GEMCAD study)

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Colon Cancer
Rectal Cancer
Translational Research
Presenter Vicente Alonso-Orduna
Citation Annals of Oncology (2014) 25 (suppl_4): iv167-iv209. 10.1093/annonc/mdu333
Authors V. Alonso-Orduna1, M. Marmol2, P. Escudero3, A. Salud4, M.J. Safont5, J.C. Méndez6, C. García Girón7, M. Martín8, C. Fernandez-Martos9, X. García Albéniz10, J. Feliu11, J. Maurel2
  • 1Servicio De Oncología Médica, Hospital Universitario Miguel Servet, 50009 - Zaragoza/ES
  • 2Oncology, H. Clínic i Provincial de Barcelona, Barcelona/ES
  • 3Servicio De Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza/ES
  • 4Oncology, Hospital Arnau de Vilanova, Lleida/ES
  • 5Oncology, H.G. de Valencia, Valencia/ES
  • 6Oncology, Centro Oncológico de Galicia, A Coruña/ES
  • 7Oncology, Hospital General Yagüe, Burgos/ES
  • 8Oncology, H. de la Santa Creu i Sant Pau, Barcelona/ES
  • 9Oncology, Instituto Valenciano de Oncología, Valencia/ES
  • 10Oncology, Harvard School of Public Health, Boston/US
  • 11Oncology, H.U. La Paz, Madrid/ES

Abstract

Aim

Background: The two main prognostic scores for mCRC (Kohne and GERCOR) do not account for resectability of liver-only metastasis (LiM) and thus are limited as treatment guidance. We propose a classification of patients based on LiM resectability, performance status (PS) and lactate dehydrogenase (LDH) levels and compare its discrimination capacity against Kohne and GERCOR scores.

Methods

We analyzed 395 patients treated with first-line oxaliplatin-based regimes with or without monoclonal antibodies. Patients were classified as stage 1 if LiM were considered resectable (<4 nodules and <5 cm diameter) or potentially resectable (>4 and <10 nodules or >5 cm diameter), PS 0-1 and LDH < 1.5 ULN; stage 2 if LiM were not resectable or with extrahepatic spread, PS 0-1 and LDH < 1.5 ULN; stage 3 if PS 2 or LDH > 1.5 ULN. This score, Kohne, and GERCOR scores were tested for discrimination using Harrel's C index (HCI, higher is better) and calibration using Akaike information criterion (AIC, smaller is better) of progression-free survival (PFS) and overall survival (OS).

Results

Group 1 Group 2 Group 3
GEMCAD
N 78 206 111
PFS HR (95% CI) 1 (Reference) 2.07 (1.54-2.78) 2.98 (2.15-4.13)
PFS HCI (95% CI) 0.66 (0.60-0.73)
PFS AIC 3496.2
OS HR (95% CI) 1 (Reference) 2.14 (1.52-3.00) 3.68 (2.55-5.32)
OS HCI (95% CI) 0.68 (0.62-0.73)
OS AIC 2903.7
Kohne
N 159 205 31
PFS HR (95% CI) 1 (Reference) 1.55 (1.23-1.93) 2.86 (1.89-4.31)
PFS HCI (95% CI) 0.62 (0.56-0.68)
PFS AIC 3515.7
OS HR (95% CI) 1 (Reference) 1.63 (1.27-2.10) 4.57 (2.93-7.13)
OS HCI (95% CI) 0.65 (0.60-0.71)
OS AIC 2915.4
GERCOR
N 116 153 126
PFS HR (95% CI) 1 (Reference) 1.40 (1.08-1.82) 2.04 (1.55-2.68)
PFS HCI (95% CI) 0.60 (0.54-0.66)
AIC 3517.7
OS HR (95% CI) 1 (Reference) 2.19 (1.62-2.96) 3.21 (2.34-4.40)
OS HCI (95% CI) 0.66 (0.62-0.71)
OS AIC 2898.4

Conclusions

Conclusions. GEMCAD score performs as well, if not better, than Kohne and GERCOR scores and allows treatment guidance.

Disclosure

All authors have declared no conflicts of interest.