Lopez-Lopez Victor, Linecker Michael, Caballero-Llanes Albert, Reese Tim, Oldhafer Karl J, Hernandez-Alejandro Roberto, Tun-Abraham Mauro, Li Jun, Fard-Aghaie Mohammad, Petrowsky Henrik, Brusadin Roberto, Lopez-Conesa Asuncion, Ratti Francesca, Aldrighetti Luca, Ramouz Ali, Mehrabi Arianeb, Autran Machado Marcel, Ardiles Victoria, De Santibañes Eduardo, Marichez Arthur, Adam René, Truant Stéphanie, Pruvot Francois-René, Olthof Pim B, Van Gulick Thomas M, Montalti Roberto, Troisi Roberto I, Kron Philipp, Lodge Peter, Kambakamba Patryk, Hoti Emir, Martinez-Caceres Carlos, de la Peña-Moral Jesus, Clavien Pierre-Alain, Robles-Campos Ricardo
Department of Surgery and Liver and Pancreas transplantation, Virgen de la Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain.
Department of Surgery and Transplantation, University Medical Center Schleswig-Holstein, Campus Kiel, Germany.
Ann Surg. 2024 Feb 1;279(2):306-313. doi: 10.1097/SLA.0000000000006024. Epub 2023 Jul 24.
Alterations in liver histology influence the liver's capacity to regenerate, but the relevance of each of the different changes in rapid liver growth induction is unknown. This study aimed to analyze the influence of the degree of histological alterations during the first and second stages on the ability of the liver to regenerate.
This cohort study included data obtained from the International ALPPS Registry between November 2011 and October 2020. Only patients with colorectal liver metastases were included in the study. We developed a histological risk score based on histological changes (stages 1 and 2) and a tumor pathology score based on the histological factors associated with poor tumor prognosis.
In total, 395 patients were included. The time to reach stage 2 was shorter in patients with a low histological risk stage 1 (13 vs 17 days, P ˂0.01), low histological risk stage 2 (13 vs 15 days, P <0.01), and low pathological tumor risk (13 vs 15 days, P <0.01). Regarding interval stage, there was a higher inverse correlation in high histological risk stage 1 group compared to low histological risk 1 group in relation with future liver remnant body weight ( r =-0.1 and r =-0.08, respectively), and future liver remnant ( r =-0.15 and r =-0.06, respectively).
ALPPS is associated with increased histological alterations in the liver parenchyma. It seems that the more histological alterations present and the higher the number of poor prognostic factors in the tumor histology, the longer the time to reach the second stage.
肝脏组织学改变会影响肝脏的再生能力，但不同变化在快速诱导肝脏生长中的相关性尚不清楚。本研究旨在分析第一阶段和第二阶段组织学改变程度对肝脏再生能力的影响。
本队列研究纳入了2011年11月至2020年10月期间从国际ALPPS注册中心获得的数据。研究仅纳入结直肠癌肝转移患者。我们基于组织学变化（1期和2期）制定了组织学风险评分，并基于与肿瘤预后不良相关的组织学因素制定了肿瘤病理评分。
共纳入395例患者。组织学风险1期低的患者、组织学风险2期低的患者以及病理肿瘤风险低的患者达到2期的时间较短（分别为13天对17天，P＜0.01；13天对15天，P＜0.01；13天对15天，P＜0.01）。关于间隔期，与低组织学风险1组相比，高组织学风险1组在未来肝残余体重方面的负相关性更高（分别为r = -0.1和r = -0.08），在未来肝残余方面也是如此（分别为r = -0.15和r = -0.06）。
ALPPS与肝实质组织学改变增加有关。似乎组织学改变越多，肿瘤组织学中预后不良因素的数量越多，达到第二阶段的时间就越长。
