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Extensive preop chemo for colorectal liver metastases linked to hepatic atrophy

Results of a recently published study showed an association between extensive preoperative chemotherapy in patients with colorectal liver metastases and hepatic atrophy, which was identified as a predictor of hepatic insufficiency and mortality.

“We present a novel measure for [total liver volume] analysis during preoperative chemotherapy that predicts surgical outcome,” the researchers wrote. “Degree of atrophy is highly predictive of [postoperative hepatic insufficiency] in patients undergoing preoperative chemotherapy and liver resection for [colorectal liver metastases]. Assessment of the [total liver volume] change following preoperative chemotherapy should be considered for incorporation into clinical practice as a surrogate marker of evaluating the risk of [postoperative hepatic insufficiency].”

Between January 2008 and December 2015, the researchers identified 459 patients who underwent curative resection for colorectal liver metastases. The study’s aim was to determine the change of total liver volume following preoperative chemotherapy and identify correlations between change in total liver volume, postoperative hepatic insufficiency and mortality from liver failure.

Patients either underwent six or fewer cycles of preoperative chemotherapy (n = 305) or seven or more cycles (n = 154).

Compared with the fewer cycles group, the group that underwent seven or more cycles had higher aspartate aminotransferase to platelet ratio index (APRI; 0.5 vs. 0.34; P < .001), higher degree of atrophy (–0.1% vs. 4%; P = .001), more frequent red blood cell transfusions (13 vs. 15; P = .021), more sinusoidal injuries (6.9% vs. 14%; P = .018) and more cases of postoperative hepatic insufficiencies (3.9% vs. 9.1%; P = .024).

As higher degrees of atrophy predicted postoperative hepatic insufficiency (area under the curve = 0.933; P < .001), the researchers determined the best cut-off value to predict postoperative hepatic insufficiency was 10%. Eighty-five patients exceeded the cut-off.

Risk factors for 10% or higher degree of atrophy after preoperative chemotherapy included seven or more cycles of preoperative chemotherapy compared with six or fewer (P = .004) and absence of bevacizumab in treatment (P = .018).

Twenty-six patients had instances of postoperative hepatic insufficiency. The risk factors for postoperative hepatic insufficiency included 30% or less standardized future liver remnant before preoperative chemotherapy (P = .019), APRI above 0.17 (P = .028), 10% or higher degree of atrophy (P < .001) and the undergoing major hepatic resection (P = .005).

“The current study evaluates a potential new predictor of postoperative outcome. The evaluation of atrophy is based on the sequential measurements of [total liver volume]. It is simple and unrelated to the duration of chemotherapy and the extent of resection,” the researchers concluded. “Furthermore, unlike functional tests such as portal vein embolization and indocyanine green clearance, it is based on [computerized tomography] only and does not require a separate procedure.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.