Aloia Thomas, Sebagh Mylène, Plasse Marylène, Karam Vincent, Lévi Francis, Giacchetti Sylvie, Azoulay Daniel, Bismuth Henri, Castaing Denis, Adam René
Department of Hepatobiliary Surgery and Liver Transplantation, Paul-Brousse Hospital, Villejuif, France.
J Clin Oncol. 2006 Nov 1;24(31):4983-90. doi: 10.1200/JCO.2006.05.8156.
Preoperative chemotherapy for colorectal liver metastases (CLM) can produce histologic changes in the nontumor-bearing liver (NTBL) that may impact on surgical outcomes.
From a cohort of 303 patients treated for CLM with liver resection, 92 patients (75 received preoperative chemotherapy: group C+; and 17 were chemotherapy naïve: group C-) were randomly selected for detailed pathologic analysis. Preoperative chemotherapy consisted of fluorouracil (FU)/leucovorin alone (23 patients, the majority chronomodulated) or in combination with oxaliplatin (52 patients, all chronomodulated). To determine associations between study factors, clinical and operative variables were compared with pathology data and surgical outcomes.
Although clinical and operative factors were similarly distributed, C+ patients, compared with C- patients, were more likely to receive intraoperative RBC transfusions (mean units: 1.9 v 0.5, respectively; P = .03) and to have vascular abnormalities in the NTBL (52% v 18%, respectively; P = .01). Presence of the most severe forms of vascular alterations was closely associated with RBC transfusion requirements (P = .04). In contrast, moderate to severe steatosis was similarly distributed (C- group, 12%; C+ group, 13%). Although perioperative mortality and morbidity rates were similar in all groups, more than 12 courses of chemotherapy, compared with < or = 12 courses, predisposed patients to reoperation (11% v 0%, respectively; P = .04) and to longer hospitalization (15 v 11 days, respectively; P = .02).
The main hepatic lesion induced by preoperative FU/oxaliplatin chemotherapy in patients with CLM is vascular and not steatosis. Detailed pathologic analysis determined that the most severe vascular lesions are associated with increased intraoperative transfusions. The risk for other postoperative complications is related to the duration of preoperative chemotherapy administration.
结直肠癌肝转移（CLM）患者术前化疗可使无瘤肝脏（NTBL）产生组织学改变，这可能会影响手术结果。
在303例行肝切除术治疗CLM的患者队列中，随机选取92例患者（75例接受术前化疗：C+组；17例未接受过化疗：C-组）进行详细的病理分析。术前化疗方案包括单纯氟尿嘧啶（FU）/亚叶酸钙（23例患者，多数采用时辰调节给药）或联合奥沙利铂（52例患者，均采用时辰调节给药）。为确定研究因素之间的关联，将临床和手术变量与病理数据及手术结果进行比较。
尽管临床和手术因素分布相似，但与C-组患者相比，C+组患者更有可能术中输注红细胞（平均输注单位分别为1.9和0.5；P = 0.03），且NTBL出现血管异常的可能性更大（分别为52%和18%；P = 0.01）。最严重的血管改变形式与红细胞输注需求密切相关（P = 0.04）。相比之下，中度至重度脂肪变性分布相似（C-组为12%；C+组为13%）。尽管所有组的围手术期死亡率和发病率相似，但化疗疗程超过12个与≤12个疗程相比，患者再次手术的可能性更大（分别为11%和0%；P = 0.04），住院时间更长（分别为15天和11天；P = 0.02）。
CLM患者术前FU/奥沙利铂化疗引起的主要肝脏病变是血管病变而非脂肪变性。详细的病理分析确定，最严重的血管病变与术中输血增加有关。其他术后并发症的风险与术前化疗给药的持续时间有关。
