Molla N W, Hassanain M M, Fadel Z, Boucher L M, Madkhali A, Altahan R M, Alrijraji E A, Simoneau E B, Alamri H, Salman A, Gao Z, Metrakos P P
Department of Surgery, Section of Hepatopancreatobiliary, and.
Department of Radiology, McGill University Health Centre, Montreal, QC.
Curr Oncol. 2017 Jun;24(3):e233-e243. doi: 10.3747/co.24.3133. Epub 2017 Jun 27.
Resection of metastases is the only potential cure for patients with liver metastasis from colorectal cancer (crc-lm). But despite an improved overall 5-year survival, the recurrence rate is still as high as 60%. Non-alcoholic fatty liver disease (nafld) can decrease the liver's capacity to regenerate after resection and might also affect cancer recurrence, potentially by elevating transforming growth factor β, levels of specific metalloproteinases, and oxidative stress. The objective of the present work was to determine the effect of the histologic features of nafld on cancer recurrence and liver regeneration.
This retrospective analysis considered 60 patients who underwent an R0 hepatectomy for crc-lm. Volumetric analysis of the liver was calculated using axial view, portovenous phase, 2.5 mm thickness, multiphasic computed tomography images taken before and after surgery. The histologic features of nafld (steatosis, inflammation, and ballooning) were scored using the nafld activity score, and the degree of fibrosis was determined.
The hepatic recurrence rate was 38.33%. Median overall survival duration was 56 months. Median disease-free survival duration was 14 months, and median hepatic disease-free survival duration was 56 months. Multivariate analysis revealed significant correlations of hepatic disease-free survival with hepatocyte ballooning ( = 0.0009), lesion diameter ( = 0.014), and synchronous disease ( = 0.006). Univariate and multivariate analyses did not reveal any correlation with degree of steatosis or recurrence rate.
This study reveals an important potential negative effect of hepatocyte ballooning on hepatic disease-free survival.
切除转移灶是结直肠癌肝转移（crc-lm）患者唯一可能的治愈方法。尽管总体5年生存率有所提高，但复发率仍高达60%。非酒精性脂肪性肝病（nafld）会降低肝切除术后肝脏的再生能力，还可能通过升高转化生长因子β、特定金属蛋白酶水平和氧化应激来影响癌症复发。本研究的目的是确定nafld的组织学特征对癌症复发和肝脏再生的影响。
本回顾性分析纳入了60例行crc-lm根治性肝切除术的患者。使用手术前后拍摄的轴向视图、门静脉期、2.5毫米层厚的多期计算机断层扫描图像计算肝脏的容积分析。使用nafld活动评分对nafld的组织学特征（脂肪变性、炎症和气球样变）进行评分，并确定纤维化程度。
肝复发率为38.33%。中位总生存时间为56个月。中位无病生存时间为14个月，中位肝无病生存时间为56个月。多变量分析显示肝无病生存与肝细胞气球样变（=0.0009）、病灶直径（=0.014）和同时性疾病（=0.006）显著相关。单变量和多变量分析均未显示与脂肪变性程度或复发率有任何相关性。
本研究揭示了肝细胞气球样变对肝无病生存的重要潜在负面影响。
