Amptoulach S, Gross G, Sturesson C, Rissler P, Kalaitzakis E
1 Department of Oncology, Skåne University Hospital, Lund University, Lund, Sweden.
2 Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
Scand J Surg. 2017 Dec;106(4):311-317. doi: 10.1177/1457496916683094. Epub 2017 Mar 1.
There are limited data on the potential role of preoperative non-invasive markers, specifically the aspartate-to-alanine aminotransferase ratio and the aspartate aminotransferase-to-platelet ratio index, in predicting perioperative liver-related complications after hepatectomy for colorectal cancer metastases.
Patients undergoing liver resection for colorectal cancer metastases in a European institution during 2003-2010 were retrospectively enrolled. Relevant data, such as neoadjuvant chemotherapy, preoperative liver function tests, and perioperative complications, were collected from medical records. The nontumorous liver parenchyma in the surgical specimens of 31 patients was re-evaluated.
Overall, 215 patients were included. In total, 40% underwent neoadjuvant chemotherapy and 47% major resection, while 47% had perioperative complications (6% liver-related). In multivariate regression analysis, the aspartate aminotransferase-to-platelet ratio index was independently associated with liver-related complications (odds ratio: 1.149, p = 0.003) and perioperative liver failure (odds ratio: 1.155, p = 0.012). The latter was also true in the subcohort of patients with neoadjuvant chemotherapy (odds ratio: 1.157, p = 0.004) but not in those without such therapy (p = 0.062). The aspartate-to-alanine aminotransferase ratio was not related to liver-related complications (p = 0.929). The area under the receiver operating characteristics curve for the aspartate aminotransferase-to-platelet ratio index as a predictor of liver-related complications was 0.857 (p = 0.008) in patients with neoadjuvant chemotherapy. Increasing aspartate aminotransferase-to-platelet ratio index was observed with an increase in degrees of sinusoidal obstruction syndrome (p = 0.01) but not for fibrosis (p = 0.175) or steatosis (p = 0.173) in the nontumorous liver in surgical specimens.
The preoperative aspartate aminotransferase-to-platelet ratio index, but not the aspartate-to-alanine aminotransferase ratio, predicts perioperative liver-related complications following hepatectomy due to colorectal cancer metastases, in particular after neoadjuvant chemotherapy. The aspartate aminotransferase-to-platelet ratio index is related to sinusoidal obstruction syndrome in the nontumorous liver.
关于术前非侵入性标志物，特别是天冬氨酸与丙氨酸转氨酶比值和天冬氨酸转氨酶与血小板比值指数，在预测结直肠癌肝转移肝切除术后围手术期肝脏相关并发症方面的潜在作用，相关数据有限。
回顾性纳入2003年至2010年期间在欧洲一家机构接受结直肠癌肝转移肝切除术的患者。从病历中收集相关数据，如新辅助化疗、术前肝功能检查和围手术期并发症。对31例患者手术标本中的非肿瘤性肝实质进行重新评估。
总共纳入215例患者。总体而言，40%的患者接受了新辅助化疗，47%的患者接受了大手术切除，47%的患者出现围手术期并发症（6%为肝脏相关并发症）。在多因素回归分析中，天冬氨酸转氨酶与血小板比值指数与肝脏相关并发症独立相关（比值比：1.149，p = 0.003）以及围手术期肝衰竭（比值比：1.155，p = 0.012）。在接受新辅助化疗的患者亚组中也是如此（比值比：1.157，p = 0.004），但在未接受此类治疗的患者中则不然（p = 0.062）。天冬氨酸与丙氨酸转氨酶比值与肝脏相关并发症无关（p = 0.929）。在接受新辅助化疗的患者中，天冬氨酸转氨酶与血小板比值指数作为肝脏相关并发症预测指标的受试者工作特征曲线下面积为0.857（p = 0.008）。在手术标本的非肿瘤性肝脏中，随着窦性阻塞综合征程度的增加，天冬氨酸转氨酶与血小板比值指数升高（p = 0.01），但与纤维化（p = 0.175）或脂肪变性（p = 0.173）无关。
术前天冬氨酸转氨酶与血小板比值指数而非天冬氨酸与丙氨酸转氨酶比值可预测结直肠癌肝转移肝切除术后围手术期肝脏相关并发症，尤其是在新辅助化疗后。天冬氨酸转氨酶与血小板比值指数与非肿瘤性肝脏中的窦性阻塞综合征相关。
