Satta Yosuke, Shigefuku Ryuta, Watanabe Tsunamasa, Mizukami Takuro, Tsuda Takashi, Suzuki Tatsuya, Ehira Takuya, Hattori Nobuhiro, Kiyokawa Hirofumi, Nakahara Kazunari, Ikeda Hiroki, Matsunaga Kotaro, Takahashi Hideaki, Matsumoto Nobuyuki, Okuse Chiaki, Suzuki Michihiro, Sunakawa Yu, Yasuda Hiroshi, Itoh Fumio
Division of Gastroenterology and Hepatology St. Marianna University School of Medicine Kawasaki Kanagawa Japan.
Department of Gastroenterology and Hepatology Mie University Graduate School of Medicine Tsu Japan.
JGH Open. 2021 Nov 2;5(11):1289-1297. doi: 10.1002/jgh3.12668. eCollection 2021 Nov.
Oxaliplatin is a key drug for the chemotherapy of colorectal cancer; however, it is also known to cause non-cirrhotic portal hypertension. We aimed to identify the characteristics of patients who developed esophagogastric varices (EGVs) after treatment with oxaliplatin.
This study retrospectively analyzed patients with colorectal cancer who were treated with chemotherapy including oxaliplatin between 2010 and 2016. All patients were evaluated by contrast-enhanced computed tomography (CE-CT) every 3 months both during and after treatment; and endoscopy was performed when appearance of portal hypertension was suspected.
A total of 106 patients were divided into two groups: EGV formation ( = 6) and EGV non-formation ( = 100). In the EGV group, platelet counts decreased and the size of the spleen calculated by CT (CT spleen index; CT-SI) increased markedly. The highest area under the receiver operating characteristic curve (AUC) for the change in platelet counts was 0.81 (80% sensitivity and 83% specificity) at 3 months post treatment, and the maximum AUC for CT-SI was 0.89 (79% sensitivity and 83% specificity) at 6 months post treatment.
EGV formation could be predicted by the assessment of platelet counts and spleen size. If progressive splenomegaly and thrombocytopenia are observed not only during but also after completion of the oxaliplatin-containing chemotherapy, EGVs should be confirmed by endoscopy for avoiding subsequent rupture.
奥沙利铂是结直肠癌化疗的关键药物；然而，它也已知会导致非肝硬化性门静脉高压。我们旨在确定接受奥沙利铂治疗后发生食管胃静脉曲张（EGV）的患者特征。
本研究回顾性分析了2010年至2016年间接受包括奥沙利铂在内的化疗的结直肠癌患者。所有患者在治疗期间和治疗后每3个月通过对比增强计算机断层扫描（CE-CT）进行评估；当怀疑出现门静脉高压时进行内镜检查。
总共106例患者分为两组：EGV形成组（n = 6）和EGV未形成组（n = 100）。在EGV组中，血小板计数下降，通过CT计算的脾脏大小（CT脾脏指数；CT-SI）显著增加。治疗后3个月血小板计数变化的受试者操作特征曲线（AUC）最高为0.81（敏感性80%，特异性83%），治疗后6个月CT-SI的最大AUC为0.89（敏感性79%，特异性83%）。
通过评估血小板计数和脾脏大小可以预测EGV的形成。如果在含奥沙利铂的化疗期间及结束后不仅观察到进行性脾肿大和血小板减少，应通过内镜检查确认EGV，以避免随后破裂。
