TY - JOUR
T1 - Hepatic atrophy following preoperative chemotherapy predicts hepatic insufficiency after resection of colorectal liver metastases
AU - Yamashita, Suguru
AU - Shindoh, Junichi
AU - Mizuno, Takashi
AU - Chun, Yun Shin
AU - Conrad, Claudius
AU - Aloia, Thomas A.
AU - Vauthey, Jean Nicolas
N1 - Funding Information:
The authors would like to recognize Ms. Ruth Haynes for the administrative support in the preparation of this manuscript. This research was supported in part by the National Institutes of Health through MD Anderson Cancer Center's Support Grant, CA016672.
Publisher Copyright:
© 2017 European Association for the Study of the Liver
PY - 2017/7
Y1 - 2017/7
N2 - Background & Aims For patients with colorectal liver metastases (CLM) undergoing major hepatectomy, extensive preoperative chemotherapy has been associated with increased morbidity and mortality. The impact of extensive chemotherapy on total liver volume (TLV) change is unclear. The aims of the current study were twofold: (1) to determine the change of TLV following preoperative chemotherapy in patients undergoing resection for CLM and (2) to investigate the correlations among TLV change, postoperative hepatic insufficiency (PHI), and death from liver failure. Methods Clinicopathological features of patients with CLM who underwent preoperative chemotherapy and curative resection were reviewed (2008–2015). TLV change (degree of atrophy) was defined as the percentage difference of TLV (estimated by manual volumetry)/standardized liver volume (SLV) ratio: ([Pre-chemotherapy TLV] − [Post-chemotherapy TLV]) × 100 ÷ SLV (%). Receiver operating characteristic (ROC) analysis was performed to decide the accurate cut-off value of degree of atrophy to predict PHI. The Cox proportional hazard model was performed to identify the predictors of severe degree of atrophy and PHI. Results The study cohort consisted of 459 patients, of which 154 patients (34%) underwent extensive preoperative chemotherapy (≥7 cycles). ROC analysis identified the degree of atrophy ≥10% as an accurate cut-off to predict PHI, which was significantly correlated with ≥7 cycles of preoperative chemotherapy. Four factors independently predicted PHI: standardized future liver remnant ≤30% (odds ratio [OR] 4.03, p = 0.019), high aspartate aminotransferase-to-platelet ratio index (OR 5.27, p = 0.028), degree of atrophy ≥10% (OR 43.5, p <0.001), and major hepatic resection (OR 5.78, p = 0.005). Degree of atrophy ≥10% was associated with increased mortality from liver failure (0% [0/374] vs. 15% [13/85], p <0.001). Conclusion Extensive preoperative chemotherapy induced significant atrophic change of TLV. Degree of atrophy ≥10% is an independent predictor of PHI and death in patients with CLM undergoing preoperative chemotherapy and resection. Lay summary Extensive preoperative chemotherapy for patients with colorectal liver metastases (CLM) could induce hepatic atrophy. A higher degree of atrophy is an independent predictor of postoperative hepatic insufficiency and death in patients with CLM undergoing preoperative chemotherapy and resection.
AB - Background & Aims For patients with colorectal liver metastases (CLM) undergoing major hepatectomy, extensive preoperative chemotherapy has been associated with increased morbidity and mortality. The impact of extensive chemotherapy on total liver volume (TLV) change is unclear. The aims of the current study were twofold: (1) to determine the change of TLV following preoperative chemotherapy in patients undergoing resection for CLM and (2) to investigate the correlations among TLV change, postoperative hepatic insufficiency (PHI), and death from liver failure. Methods Clinicopathological features of patients with CLM who underwent preoperative chemotherapy and curative resection were reviewed (2008–2015). TLV change (degree of atrophy) was defined as the percentage difference of TLV (estimated by manual volumetry)/standardized liver volume (SLV) ratio: ([Pre-chemotherapy TLV] − [Post-chemotherapy TLV]) × 100 ÷ SLV (%). Receiver operating characteristic (ROC) analysis was performed to decide the accurate cut-off value of degree of atrophy to predict PHI. The Cox proportional hazard model was performed to identify the predictors of severe degree of atrophy and PHI. Results The study cohort consisted of 459 patients, of which 154 patients (34%) underwent extensive preoperative chemotherapy (≥7 cycles). ROC analysis identified the degree of atrophy ≥10% as an accurate cut-off to predict PHI, which was significantly correlated with ≥7 cycles of preoperative chemotherapy. Four factors independently predicted PHI: standardized future liver remnant ≤30% (odds ratio [OR] 4.03, p = 0.019), high aspartate aminotransferase-to-platelet ratio index (OR 5.27, p = 0.028), degree of atrophy ≥10% (OR 43.5, p <0.001), and major hepatic resection (OR 5.78, p = 0.005). Degree of atrophy ≥10% was associated with increased mortality from liver failure (0% [0/374] vs. 15% [13/85], p <0.001). Conclusion Extensive preoperative chemotherapy induced significant atrophic change of TLV. Degree of atrophy ≥10% is an independent predictor of PHI and death in patients with CLM undergoing preoperative chemotherapy and resection. Lay summary Extensive preoperative chemotherapy for patients with colorectal liver metastases (CLM) could induce hepatic atrophy. A higher degree of atrophy is an independent predictor of postoperative hepatic insufficiency and death in patients with CLM undergoing preoperative chemotherapy and resection.
KW - Colorectal liver metastases
KW - Postoperative hepatic insufficiency
KW - Preoperative chemotherapy
KW - Total liver volume
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U2 - 10.1016/j.jhep.2017.01.031
DO - 10.1016/j.jhep.2017.01.031
M3 - Article
C2 - 28192187
AN - SCOPUS:85015801747
SN - 0168-8278
VL - 67
SP - 56
EP - 64
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 1
ER -