Division of Hepato-Biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Saint-Luc University Hospital, Université Catholique de Louvain (UCL), Hippocrate Avenue, 10 1200 Brussels, Belgium.
Department of Digestive Surgery, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium.
Eur J Surg Oncol. 2018 Oct;44(10):1532-1538. doi: 10.1016/j.ejso.2018.07.050. Epub 2018 Jul 27.
The prevalence of chemotherapy associated liver injuries (CALI), especially SOS (sinusoidal obstruction syndrome) and NRH (nodular regenerative hyperplasia) might be reduced since the introduction of routine use of biological agents with chemotherapy in colorectal liver metastases (CRLM).
One hundred patients with CRLM having undergone at least one liver segment resection were prospectively included, and chemotherapy data recorded. Specimens were reviewed by a single pathologist and CALI were described. Prevalence of CALI was compared to our previous experience published in 2013. NRH diagnosis was performed on reticulin special stain, by contrast to our previous study. Postoperative outcome was analysed.
Bevacizumab was more frequently administrated in patients of the present study: 53/100 (53%) compared to 20/151 (13%), p < 0.0001. Overall, in the present series, SOS was only observed in 28/100 (28%) patients compared to 116/151 (77%) in 2013 (p < 0.001). When looking specifically to patients receiving Bevacizumab with Folfox, we observed a reduced SOS prevalence compared to Folfox alone (p = 0.008). A higher prevalence of NRH was found in the present study, related to increased detection accuracy, but in patients receiving Bevacizumab in association with Folfox, this prevalence was also reduced compared to Folfox alone (p = 0.03). Both SOS and NRH were associated with severe complications (p = 0.008 and p = 0.005, respectively) and postoperative liver insufficiency (p < 0.001 and p < 0.01, respectively).
The routine use of Bevacizumab in association with Folfox significantly reduced CALI prevalence, in turn linked to severe postoperative complications.
由于在结直肠癌肝转移（CRLM）中常规使用化疗联合生物制剂，化疗相关肝损伤（CALI），尤其是 SOS（窦状隙阻塞综合征）和 NRH（结节性再生性增生）的发生率可能降低。
前瞻性纳入了 100 例至少接受过一次肝段切除术的 CRLM 患者，并记录化疗数据。由一名病理学家对标本进行复查并描述 CALI。将 CALI 的发生率与我们 2013 年发表的既往经验进行比较。NRH 的诊断通过网状纤维特殊染色进行，与我们之前的研究不同。分析术后结果。
本研究中贝伐珠单抗的使用率更高：100 例患者中有 53 例（53%），而 151 例患者中有 20 例（13%），p<0.0001。总体而言，在本系列中，仅观察到 100 例患者中有 28 例（28%）出现 SOS，而在 2013 年的 151 例患者中有 116 例（77%），p<0.001。当专门观察接受贝伐珠单抗联合 Folfox 的患者时，与单独接受 Folfox 相比，SOS 发生率降低（p=0.008）。本研究发现 NRH 的发生率更高，这与检测准确性的提高有关，但与单独接受 Folfox 相比，接受贝伐珠单抗联合 Folfox 的患者 NRH 发生率也降低（p=0.03）。SOS 和 NRH 均与严重并发症相关（p=0.008 和 p=0.005）和术后肝功能不全相关（p<0.001 和 p<0.01）。
贝伐珠单抗联合 Folfox 的常规使用显著降低了 CALI 的发生率，这反过来又与严重的术后并发症相关。
