Background: The aim of this study was to develop a prediction model for 10-year overall survival (OS) after resection of colorectal liver metastasis (CRLM) based on patient, tumour and treatment... Show moreBackground: The aim of this study was to develop a prediction model for 10-year overall survival (OS) after resection of colorectal liver metastasis (CRLM) based on patient, tumour and treatment characteristics.Methods: Consecutive patients after complete resection of CRLM were included from two centres (1992-2019). A prediction model providing 10-year OS probabilities was developed using Cox regression analysis, including KRAS, BRAF and histopathological growth patterns. Discrimination and calibration were assessed using cross-validation. A web-based calculator was built to predict individual 10-year OS probabilities.Results: A total of 4112 patients were included. The estimated 10-year OS was 30% (95% CI 29 -32). Fifteen patient, tumour and treatment characteristics were independent prognostic factors for 10-year OS; age, gender, location and nodal status of the primary tumour, disease-free interval, number and diameter of CRLM, preoperative CEA, resection margin, extrahepatic disease, KRAS and BRAF mutation status, histopathological growth patterns, perioperative systemic chemotherapy and hepatic arterial infusion pump chemotherapy. The discrimination at 10-years was 0.73 for both centres. A simplified risk score identified four risk groups with a 10-year OS of 57%, 38%, 24%, and 12%.Conclusions: Ten-year OS after resection of CRLM is best predicted with a model including 15 patient, tumour, and treatment characteristics. The web-based calculator can be used to inform patients. This model serves as a benchmark to determine the prognostic value of novel biomarkers. (C) 2022 The Author(s). Published by Elsevier Ltd. Show less
Proximal femoral fractures (often denoted as hip fractures) are amongst the most prevalent fractures in older patients and associated with significant mortality and morbidity.Failure to recover to... Show moreProximal femoral fractures (often denoted as hip fractures) are amongst the most prevalent fractures in older patients and associated with significant mortality and morbidity.Failure to recover to prefracture levels of function has important social and economic implications, as these patient’s risk losing their independence and self-reliance. The primary aim of this thesis is to provide a better understanding of the factors relevant for the functional prognosis of patients with a proximal femoral fracture.This thesis covers two parts, focusing on the effects of surgical aspects and patient demographics.Outcomes of previously performed studies on prognostic factors of recovery proved hard to compare. This can be attributed to the high level of heterogeneity and methodology of these studies, for instance in the method to objectify recovery. For the studies in this thesis, we have opted to compare outcomes with the patients’ individual prefracture level of function. Surgical aspects, such as different approaches to place a prosthesis, seemed to have a reserved effect on recovery. Factors which seemed of conclusive relevance were health scores based on the comorbidity and prefracture level of function. This emphasizes the importance of a holistic and geriatric approach for patients with proximal hip fractures. Show less
