Histopathological Helsinki score of colorectal liver metastases predicts survival after liver resection.

AIM: Several perioperative scoring systems have been created to predict outcomes in metastatic colorectal cancer; however, these rarely include histological parameters. We evaluated histological factors used for patients with liver metastases operated between 2000 and 2019 and compared the results with the Fong score.

EXPERIMENTAL DESIGN: Many scoring models for overall disease-free survival (DFS) were established and compared using multivariate Cox proportional hazard models. Statistically significant predictors at a 5% level in the univariate analysis were included in the multivariate models using the backward and forward selection methods. Per these models, we established a score of eight histological factors. We defined low-, intermediate-, and high-risk groups and compared them using the Kaplan-Meier survival and receiver operating characteristics (ROC) analyses. The histological score's accuracy was compared with the modified Fong clinical risk score.

RESULTS: The following factors constituted the Helsinki score: advanced pT stage, node-positive primary, ≥2 metastases, size >50 mm, vitality >30%, margin <5 mm, vascular invasion, and biliary invasion. The high-risk group had significantly worse DFS and overall survival. In ROC analyses, the Helsinki score was slightly better than the modified Fong clinical risk score.

CONCLUSIONS: Helsinki score challenges physicians to acknowledge histological factors as important outcome measures.