Choti Michael A
Department of Surgery, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Surg Oncol. 2009 Sep;16(9):2391-4. doi: 10.1245/s10434-009-0512-7. Epub 2009 Jun 25.
Curative resection of liver metastases from colorectal cancer is associated with improved overall survival rates, making complete resection the goal of therapy for many patients. The addition of newer, more active chemotherapeutic regimens has prolonged patient survival in those with advanced disease and increased the number of patients eligible for surgical therapy. However, concerns regarding chemotherapy-associated liver injury may have a negative impact on the ability to offer potentially curative therapy and may increase morbidity in some patients. Specific forms of liver injury have been associated with various chemotherapeutic regimens, including steatosis and steatohepatitis with prolonged fluorouracil and irinotecan therapy, and sinusoidal injury with oxaliplatin-based regimens. While the histologic association appears likely, the contribution of chemotherapy-associated hepatotoxicity to postoperative morbidity remains ill defined.
结直肠癌肝转移的根治性切除与总体生存率的提高相关，这使得完全切除成为许多患者的治疗目标。更新的、更有效的化疗方案的加入延长了晚期疾病患者的生存期，并增加了适合手术治疗的患者数量。然而，对化疗相关肝损伤的担忧可能会对提供潜在治愈性治疗的能力产生负面影响，并可能增加一些患者的发病率。特定形式的肝损伤与各种化疗方案有关，包括长期使用氟尿嘧啶和伊立替康治疗导致的脂肪变性和脂肪性肝炎，以及基于奥沙利铂的方案导致的窦性损伤。虽然组织学关联似乎很可能存在，但化疗相关肝毒性对术后发病率的影响仍不明确。
