Multicentre validation of a clinical prognostic score integrating the systemic inflammatory response to the host for patients treated with curative-intent for colorectal liver metastases: The Liverpool score

Research output: Contribution to journalArticlepeer-review


  • A Dupré
  • A W H Chan
  • M Rivoire
  • C C N Chong
  • P B S Lai
  • A Cucchetti
  • Graeme J Poston
  • H Z Malik
  • P J Johnson

Colleges, School and Institutes

External organisations

  • Aintree University Hospitals NHS Foundation Trust
  • University of Liverpool
  • The Chinese University of Hong Kong
  • Centre Léon Bérard
  • Università di Bologna


BACKGROUND: This study aimed to create a new prognostic score integrating the systemic inflammatory response to predict survival in patients treated with curative intent for colorectal liver metastases (CLM).

METHODS: We identified independent prognostic factors in patients who underwent liver surgery for CLM in a tertiary centre in the United Kingdom (UK) between 2010 and 2015. A pre- and a postoperative score (Liverpool score) were created by combining these factors to stratify patients into different risk groups. These new scores were validated in an international cohort of 219 patients from China and France.

RESULTS: Multivariate cox regression analysis of the 364 patients of the UK cohort identified 6 preoperative and 1 postoperative prognostic factors for overall survival (OS): American society of anaesthesiologists (ASA) score, location and node status of the primary tumour, number and size of CLM, neutrophil-to-lymphocyte ratio (NLR) and resection margin. Both pre- and postoperative scores can be calculated with an online calculator at Using the pre-operative model on the UK cohort, median OS was 61.22 (50.23, not reached) months in the low-risk group (n = 162) and 30.36 (23.68, 35.95) months in the high-risk group (n = 162, p < 0.0001). The same difference was observed in the validation cohort. The Liverpool score outperformed previously published scoring system with a c-index of 0.619 pre-operatively and of 0.637 post-operatively.

CONCLUSION: We developed a new prognostic score based on clinicopathologic characteristics including the site of the primary tumour location and on measurement of the systemic inflammatory response which could help to tailor patients' management.

Bibliographic note

Copyright © 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.


Original languageEnglish
Pages (from-to)999-1004
Number of pages6
JournalEuropean Journal of Surgical Oncology
Issue number6
Early online date21 Feb 2019
Publication statusPublished - Jun 2019


  • Aged, Colorectal Neoplasms/complications, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Incidence, Liver Neoplasms/diagnosis, Male, Middle Aged, Prognosis, Retrospective Studies, Survival Rate/trends, Systemic Inflammatory Response Syndrome/diagnosis, United Kingdom/epidemiology