预测结直肠肝转移瘤患者接受奥沙利铂为基础的化疗后发生肝窦阻塞综合征高分级病变：与肝切除术后结局的相关性。

Predicting high grade lesions of sinusoidal obstruction syndrome related to oxaliplatin-based chemotherapy for colorectal liver metastases: correlation with post-hepatectomy outcome.

机构信息

Department of Hepatobiliary Surgery, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.

出版信息

Ann Surg. 2010 Mar;251(3):454-60. doi: 10.1097/SLA.0b013e3181c79403.

DOI:10.1097/SLA.0b013e3181c79403

PMID:20160638

Abstract

BACKGROUND/OBJECTIVE: Oxaliplatin-based chemotherapy induces sinusoidal obstruction syndrome (SOS) lesions in the nontumorous liver parenchyma, which may increase the risk of liver resection for colorectal liver metastases. The objective of this study was to evaluate the accuracy of aspartate aminotransferase to platelet ratio index (APRI) and FIB-4 scoring systems to predict chemotherapy-associated liver injury and to correlate the severity of sinusoidal injury with postoperative outcome.

METHODS

Between 1998 and 2007, 78 patients were operated for colorectal liver metastases after preoperative oxaliplatin-based chemotherapy. Grading of steatosis and SOS in the nontumorous liver parenchyma was obtained in these patients. Univariate analysis of 18 preoperative factors to predict SOS occurrence was performed as well as multivariate analysis. Relevance of preoperative platelet count level, transaminase levels, and fibrosis scoring systems were evaluated to predict high grade lesions of SOS using a receiving operative curve analysis. Ninety-day mortality and morbidity were studied according to SOS severity in 51 patients who underwent major liver resection.

RESULTS

Overall, pathologic examination showed high-grade lesions of SOS (SOS 2/3) in 46 (59%) patients. Univariate analysis showed that a low preoperative platelet count, elevated preoperative aspartate aminotransferase, short interval between chemotherapy and surgery were significant factors associated with high-grade lesions of SOS. Multivariate analysis showed that only the APRI score was an independent predictive factor for severe SOS. Receiving operative curve analysis revealed that the cut-off value predicting high-grade lesions of SOS with the best accuracy was an APRI score of 0.36 (area under the curve, 0.85; sensitivity, 87%; specificity, 69%). After major liver resection (n = 51), SOS 2/3 (n = 38) was associated with postoperative hepatic dysfunction (26/38 in SOS 2/3 vs. 3/13 in SOS 0/1; P = 0.004) and ascites (P = 0.03).

CONCLUSION

A low preoperative platelet count and high APRI score seem to be the most reliable indicators to predict SOS severity.

摘要

背景/目的：奥沙利铂为基础的化疗会在非肿瘤性肝实质中引起窦状隙阻塞综合征（SOS）病变，这可能会增加结直肠癌肝转移患者行肝切除术的风险。本研究的目的是评估天冬氨酸转氨酶血小板比值指数（APRI）和纤维化-4 评分系统预测化疗相关肝损伤的准确性，并将窦状隙损伤的严重程度与术后结果相关联。

方法

1998 年至 2007 年间，有 78 例接受过奥沙利铂为基础的化疗的结直肠癌肝转移患者接受了手术治疗。对这些患者的非肿瘤性肝实质中的脂肪变性和 SOS 分级进行了评估。对 18 个术前因素进行了单因素分析以预测 SOS 的发生，并进行了多因素分析。采用接收操作曲线分析，评估术前血小板计数水平、转氨酶水平和纤维化评分系统对预测 SOS 高级别病变的相关性。根据 51 例接受大肝切除术的患者的 SOS 严重程度，研究了 90 天死亡率和发病率。

结果

总体而言，病理检查显示 46 例（59%）患者存在高级别 SOS（SOS 2/3）病变。单因素分析显示，术前血小板计数低、术前天门冬氨酸转氨酶升高、化疗与手术之间的间隔短是与高级别 SOS 相关的显著因素。多因素分析显示，只有 APRI 评分是严重 SOS 的独立预测因素。接收操作曲线分析显示，预测高级别 SOS 的最佳准确性的截断值是 APRI 评分 0.36（曲线下面积为 0.85；敏感性为 87%；特异性为 69%）。在大肝切除术后（n=51），SOS 2/3（n=38）与术后肝功能障碍（SOS 2/3 为 26/38，SOS 0/1 为 3/13；P=0.004）和腹水（P=0.03）相关。