Clinical and Experimental Medicine PhD program, University of Modena and Reggio Emilia, Modena, Italy.
Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
BMC Cancer. 2021 Mar 9;21(1):253. doi: 10.1186/s12885-021-07980-9.
The liver is one of the most frequent sites of metastases in rectal cancer. This study aimed to evaluate how the development of synchronous or metachronous liver metastasis and overall survival are impacted by baseline liver steatosis and chemotherapy-induced liver damage in rectal cancer patients.
Patients diagnosed with stage II to IV rectal cancer between 2010 and 2016 in our province with suitable baseline CT scan were included. Data on cancer diagnosis, staging, therapy, outcomes and liver function were collected. CT scans were retrospectively reviewed to assess baseline steatosis (liver density < 48 HU and/or liver-to-spleen ratio < 1.1). Among patients without baseline steatosis and treated with neoadjuvant chemotherapy, chemotherapy-induced liver damage was defined as steatosis appearance, ≥ 10% liver volume increase, or significant increase in liver function tests.
We included 283 stage II to IV rectal cancer patients with suitable CT scan (41% females; mean age 68 ± 14 years). Steatosis was present at baseline in 90 (31.8%) patients, synchronous liver metastasis in 42 (15%) patients and metachronous liver metastasis in 26 (11%); 152 (54%) deaths were registered. The prevalence of synchronous liver metastasis was higher in patients with steatosis (19% vs 13%), while the incidence of metachronous liver metastasis was similar. After correcting for age, sex, stage, and year of diagnosis, steatosis was not associated with metachronous liver metastasis nor with overall survival. In a small analysis of 63 patients without baseline steatosis and treated with neoadjuvant chemotherapy, chemotherapy-induced liver damage was associated with higher incidence of metachronous liver metastasis and worse survival, results which need to be confirmed by larger studies.
Our data suggest that rectal cancer patients with steatosis had a similar occurrence of metastases during follow-up, even if the burden of liver metastases at diagnosis was slightly higher, compatible with chance.
肝脏是直肠癌转移最常见的部位之一。本研究旨在评估直肠癌患者基线肝脂肪变性和化疗性肝损伤对同步或异时性肝转移发展和总生存的影响。
纳入 2010 年至 2016 年在我省诊断为 II 期至 IV 期直肠癌且有合适基线 CT 扫描的患者。收集癌症诊断、分期、治疗、结果和肝功能的数据。回顾性分析 CT 扫描以评估基线脂肪变性（肝密度<48HU 和/或肝脾比值<1.1）。在无基线脂肪变性且接受新辅助化疗的患者中，化疗性肝损伤定义为脂肪变性出现、肝体积增加≥10%或肝功能检查显著增加。
我们纳入了 283 名有合适 CT 扫描的 II 期至 IV 期直肠癌患者（41%为女性；平均年龄 68±14 岁）。90 例（31.8%）患者基线存在脂肪变性，42 例（15%）患者存在同步肝转移，26 例（11%）患者存在异时性肝转移；共登记 152 例死亡。有脂肪变性的患者同步肝转移的发生率较高（19% vs 13%），而异时性肝转移的发生率相似。在校正年龄、性别、分期和诊断年份后，脂肪变性与异时性肝转移或总生存无关。在对 63 例无基线脂肪变性且接受新辅助化疗的患者进行的小型分析中，化疗性肝损伤与更高的异时性肝转移发生率和更差的生存相关，这些结果需要更大规模的研究来证实。
我们的数据表明，有脂肪变性的直肠癌患者在随访期间转移的发生率相似，尽管诊断时肝转移的负担略高，但这可能是偶然的。
