Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China.
Center of Evidence-Based Medicine, Fudan University, Shanghai, P.R. China.
Endoscopy. 2020 Sep;52(9):727-735. doi: 10.1055/a-1157-8611. Epub 2020 May 7.
Oxaliplatin, used as first-choice treatment for colorectal cancer (CRC), induces sinusoidal endothelial injury and portal hypertension. This study investigated the characteristics of oxaliplatin-induced portal hypertension and evaluated the efficacy of endoscopic management of gastroesophageal variceal bleeding. METHODS : We performed a retrospective, multicenter, case-control study between January 2010 and December 2018. Patients who received oxaliplatin-based chemotherapy after CRC surgery and presented with portal hypertension and gastroesophageal varices were compared with consecutive patients with hepatitis B-related cirrhotic portal hypertension receiving endoscopic treatment for variceal bleeding. RESULTS : 39 patients with oxaliplatin-induced portal hypertension were identified, 35 of whom had a history of variceal bleeding. The median period between start of oxaliplatin-based chemotherapy and the occurrence of varices was 50.4 months (n = 39). A total of 26 patients with oxaliplatin-related portal hypertension and 230 patients with hepatitis B-related portal hypertension underwent endoscopic treatment. Kaplan-Meier analysis revealed that the 1-year rebleeding rate was significantly higher in the oxaliplatin group than in the hepatitis B group (43.3 % vs. 19.0 %, = 0.001). Multivariable Cox regression analysis showed that oxaliplatin-based chemotherapy was an independent factor for 3-year rebleeding (hazard ratio [HR] 2.46, 95 % confidence interval [CI] 1.24-4.87; = 0.01) and 3-year overall mortality (HR 9.43, 95 %CI 2.32-38.31; = 0.002). CONCLUSIONS : Oxaliplatin-related portal hypertension was characterized by massive ascites, splenomegaly, gastric varices, concomitant arterioportal fistula, and relatively normal liver function. Endoscopic treatment to prevent variceal rebleeding in these patients was unsatisfactory compared with endoscopic treatment for hepatitis B-related portal hypertension.
奥沙利铂作为结直肠癌（CRC）的首选治疗药物，会引起肝窦内皮损伤和门静脉高压。本研究旨在探讨奥沙利铂诱导的门静脉高压的特征，并评估内镜治疗胃食管静脉曲张出血的疗效。方法：我们进行了一项回顾性、多中心、病例对照研究，研究对象为 2010 年 1 月至 2018 年 12 月期间接受 CRC 手术后接受奥沙利铂为基础的化疗并出现门静脉高压和胃食管静脉曲张的患者，与连续接受内镜治疗的乙型肝炎相关肝硬化门静脉高压患者进行比较。结果：共发现 39 例奥沙利铂诱导的门静脉高压患者，其中 35 例有静脉曲张出血史。从开始奥沙利铂为基础的化疗到静脉曲张出现的中位时间为 50.4 个月（n = 39）。26 例奥沙利铂相关门静脉高压患者和 230 例乙型肝炎相关门静脉高压患者接受了内镜治疗。Kaplan-Meier 分析显示，奥沙利铂组 1 年再出血率明显高于乙型肝炎组（43.3%比 19.0%， = 0.001）。多变量 Cox 回归分析显示，奥沙利铂为基础的化疗是 3 年再出血（危险比[HR]2.46，95%置信区间[CI]1.24-4.87； = 0.01）和 3 年总死亡率（HR 9.43，95%CI 2.32-38.31； = 0.002）的独立因素。结论：奥沙利铂相关门静脉高压的特征为大量腹水、脾肿大、胃静脉曲张、同时伴有动静脉瘘和相对正常的肝功能。与乙型肝炎相关门静脉高压的内镜治疗相比，这些患者预防静脉曲张再出血的内镜治疗效果并不理想。
