Slade Julian H, Alattar Mona L, Fogelman David R, Overman Michael J, Agarwal Atin, Maru Dipen M, Coulson Ryanne L, Charnsangavej Chusilp, Vauthey J Nicolas, Wolff Robert A, Kopetz Scott
Department of Pharmacy, The University of Texas M. D. Anderson Cancer Center, Houston, 77030, USA.
Clin Colorectal Cancer. 2009 Oct;8(4):225-30. doi: 10.3816/CCC.2009.n.038.
Oxaliplatin-based chemotherapy regimens are currently a standard of care for the treatment of colorectal cancer (CRC) in both the adjuvant treatment and metastatic disease settings. Significant improvements in outcomes have been achieved with oxaliplatin-based combinations in these settings when compared with administration of 5-fluorouracil alone. Pathologic evaluation of normal liver from patients undergoing neoadjuvant oxaliplatin treatment has identified histologic evidence of sinusoidal injury, although the effect of this finding on patient outcomes after hepatic resection appears to be minimal. This article describes the use of oxaliplatin-based chemotherapy in 6 patients with stage III or IV CRC who developed evidence of noncirrhotic portal hypertension. These patients developed complications of portal hypertension including esophageal or hemorrhoidal varices with bleeding, splenomegaly with associated thrombocytopenia, and ascites. In each case, oxaliplatin-induced hepatic sinusoidal injury was identified as the most likely factor contributing to the development of noncirrhotic portal hypertension. The literature on hepatic sinusoidal injury after oxaliplatin is reviewed and the proposed pathophysiology is discussed.
基于奥沙利铂的化疗方案目前是辅助治疗和转移性疾病环境中结直肠癌（CRC）治疗的标准护理。与单独使用5-氟尿嘧啶相比，在这些环境中基于奥沙利铂的联合治疗在治疗效果上有了显著改善。对接受新辅助奥沙利铂治疗的患者的正常肝脏进行病理评估，发现了肝窦损伤的组织学证据，尽管这一发现对肝切除术后患者预后的影响似乎很小。本文描述了6例III期或IV期CRC患者使用基于奥沙利铂的化疗后出现非肝硬化门静脉高压证据的情况。这些患者出现了门静脉高压并发症，包括食管或痔静脉曲张伴出血、脾肿大伴相关血小板减少症和腹水。在每种情况下，奥沙利铂诱导的肝窦损伤被确定为导致非肝硬化门静脉高压发生的最可能因素。本文回顾了奥沙利铂治疗后肝窦损伤的相关文献，并讨论了其提出的病理生理学机制。
