Predictive value of genetic and morphological evaluation (GAME) score for outcomes after thermal ablation in patients with colorectal liver metastases.

Abstract

Objective: To evaluate the predictive value of the genetic and morphological evaluation (GAME) score for the prognosis of patients with colorectal liver metastases (CRLM) receiving thermal ablation (TA) and compare it with the Fong score.

Materials and methods: We conducted a retrospective analysis of CRLM patients who underwent TA between January 2016 and December 2021 at two tertiary medical centers in China. Recurrence-free survival (RFS) and overall survival (OS) were evaluated using Kaplan-Meier curves and log-rank testing. Prognostic variables associated with early recurrence (ER) and OS were identified through univariate and multivariate Cox regression, and nomograms were developed based on significant factors.

Results: Both the GAME and Fong scores effectively predicted RFS and OS in patients with CRLM undergoing TA treatment, though the GAME score showed superior discriminatory ability. Cox regression identified the largest liver metastasis diameter (HR: 0.45, 95% CI: 0.29-0.69; p < 0.001) and GAME group (HR: 1.88, 95% CI: 1.13-3.12; p = 0.015) as independent prognostic factors for ER. The largest liver metastasis diameter (HR: 0.49, 95% CI: 0.31-0.78; p = 0.003), image-guidance technique (HR: 2.10, 95% CI: 1.04-4.27; p = 0.039) and GAME group (HR: 1.88, 95% CI: 1.12-3.16; p = 0.017) were independent prognostic factors for OS. Based on these findings, nomograms with good discrimination and calibration were constructed.

Conclusion: The GAME score, which outperforms the Fong score in predicting the prognosis of patients with CRLM who meet the stringent eligibility criteria of this study and undergo TA, should be considered a preoperative prognostic tool.