Angitapalli Revathi, Litwin Alan M, Kumar Prasanna R G, Nasser Eiad, Lombardo Jeffrey, Mashtare Terry, Wilding Gregory E, Fakih Marwan G
Arlington Cancer Center, Arlington, TX, USA.
Oncology. 2009;76(5):363-8. doi: 10.1159/000210025. Epub 2009 Mar 25.
The impact of adjuvant chemotherapy on hepatic function and portal hypertension in patients with stages II-III colon cancer has not been previously described. We conducted a retrospective study to assess the effects of adjuvant FOLFOX chemotherapy on the splenic index (SI) as a surrogate marker for portal hypertension.
Stage II-III colorectal cancer patients treated with adjuvant FOLFOX or fluorouracil/leucovorin (5-FU/LV) at Roswell Park Cancer Institute between 2002 and 2006 were identified. Computerizedt omography (CT) scans obtained prior to and at completion of chemotherapy, and every 6 months thereafter were reviewed. Splenic size was evaluated using the SI (SI = length x width x height of the spleen).
40 patients were identified in the FOLFOX group and 23 in the 5-FU/LV group. After 6 months of adjuvant chemotherapy, the mean increase in SI was 45.7 and 16.3% in the FOLFOX and 5-FU/LV groups, respectively (p = 0.0069). SI increased by >100% in 6 patients (15%) in the FOLFOX group versus none in the 5-FU/LV group (p = 0.16). The mean SI at completion of adjuvant chemotherapy was significantly higher in the FOLFOX group than in the 5-FU/LV group (p = 0.007). The mean SI decreased steadily over a period of 2 years after discontinuation of FOLFOX, suggesting potential reversibility of oxaliplatin-induced hepatic injury in this setting.
Adjuvant FOLFOX significantly increases the SI in patients with resected colorectal cancer in comparison to adjuvant 5-FU/LV. The increase in SI may be a marker of oxaliplatin-induced hepatic injury and should be investigated further in prospective longitudinal studies of oxaliplatin-based adjuvant chemotherapy.
辅助化疗对II - III期结肠癌患者肝功能和门静脉高压的影响此前尚未见报道。我们进行了一项回顾性研究，以评估辅助性FOLFOX化疗对作为门静脉高压替代标志物的脾指数（SI）的影响。
确定2002年至2006年期间在罗斯韦尔帕克癌症研究所接受辅助性FOLFOX或氟尿嘧啶/亚叶酸钙（5-FU/LV）治疗的II - III期结直肠癌患者。回顾化疗前、化疗结束时以及此后每6个月获得的计算机断层扫描（CT）图像。使用脾指数（SI = 脾脏长度×宽度×高度）评估脾脏大小。
FOLFOX组确定了40例患者，5-FU/LV组确定了23例患者。辅助化疗6个月后，FOLFOX组和5-FU/LV组的SI平均增加分别为45.7%和16.3%（p = 0.0069）。FOLFOX组有6例患者（15%）的SI增加超过100%，而5-FU/LV组无此情况（p = 0.16）。辅助化疗结束时，FOLFOX组的平均SI显著高于5-FU/LV组（p = 0.007）。停用FOLFOX后2年内，平均SI稳步下降，提示在此情况下奥沙利铂诱导的肝损伤可能具有可逆性。
与辅助性5-FU/LV相比，辅助性FOLFOX显著增加了接受结直肠癌切除术患者的SI。SI的增加可能是奥沙利铂诱导肝损伤的标志物，应在基于奥沙利铂的辅助化疗的前瞻性纵向研究中进一步研究。
