Hepatobiliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
Okinaka Memorial Institute for Medical Disease, Tokyo, Japan.
Ann Surg Oncol. 2019 Nov;26(12):4100-4107. doi: 10.1245/s10434-019-07740-x. Epub 2019 Aug 22.
The purpose of this study was to investigate the incidence, origin, and clinical significance of liver atrophy during chemotherapy for colorectal cancer.
This study included 103 patients who underwent chemotherapy before resection for colorectal liver metastases (training set) and 171 patients who underwent adjuvant or first-line chemotherapy without liver resection (validation set). A greater than 10% decrease (atrophy) or increase (hypertrophy) of the liver volume from the baseline was defined as a significant change.
In the training set, the numbers of patients who developed atrophy, no change of volume, and hypertrophy of the liver after chemotherapy were 15 (14.6%), 73 (70.9%), and 15 (14.6%), respectively. Liver atrophy was associated with impaired hepatic function, and the postoperative morbidity rate and refractory ascites/pleural effusion were higher in the patients with liver atrophy than those without (60.0% vs. 31.8%, P = 0.045 and 46.7% vs. 8.0%, P < 0.001, respectively). Histopathological examination revealed a strong association between sinusoidal injury and liver atrophy (P < 0.001). The cumulative incidence of liver atrophy increased with increasing duration of chemotherapy, whereas the incidence of liver atrophy was less frequent in patients who had received bevacizumab than those who had not in both the training set (odds ratio [OR], 0.13; P = 0.001) and the validation set (OR, 0.31; P = 0.007).
Liver atrophy is associated with impaired hepatic functional reserve and observed at an increasing frequency as the duration of chemotherapy increases with frequent histopathological evidence of sinusoidal injury in the liver. Bevacizumab may protect against the development of liver atrophy.
本研究旨在探讨结直肠癌化疗过程中肝脏萎缩的发生率、来源及其临床意义。
本研究纳入了 103 例接受结直肠肝转移切除术化疗前（训练集）和 171 例未行肝切除术的辅助或一线化疗患者（验证集）。肝脏体积较基线减少 10%以上（萎缩）或增加（肥大）定义为显著变化。
在训练集中，化疗后肝脏出现萎缩、体积无变化和肥大的患者分别为 15 例（14.6%）、73 例（70.9%）和 15 例（14.6%）。肝脏萎缩与肝功能受损有关，且萎缩患者术后发病率和难治性腹水/胸腔积液发生率高于无萎缩患者（60.0% vs. 31.8%，P=0.045 和 46.7% vs. 8.0%，P<0.001）。组织病理学检查显示，窦状隙损伤与肝脏萎缩有很强的相关性（P<0.001）。随着化疗时间的延长，肝脏萎缩的累积发生率增加，而在训练集和验证集中，贝伐珠单抗治疗组肝脏萎缩的发生率均低于未治疗组（比值比 [OR]，0.13；P=0.001 和 OR，0.31；P=0.007）。
肝脏萎缩与肝储备功能受损有关，随着化疗时间的延长，其发生率逐渐增加，且肝脏组织病理学常显示窦状隙损伤。贝伐珠单抗可能预防肝脏萎缩的发生。
