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Preop chemo-related liver injuries persist for 9 months or longer

In patients treated with preoperative chemotherapy prior to resection for colorectal liver metastases, sinusoidal dilation and nodular regenerative hyperplasia did not regress until 9 months post-chemotherapy, while steatosis and steatohepatitis persisted even longer, according to a recent study.

“[Chemotherapy-associated liver injuries] have an important clinical impact, being associated with higher postoperative morbidity and mortality,” the researchers wrote. “In this context, the reversibility of [chemotherapy-associated liver injury] is of interest for at least two reasons. First, knowing more about its reversibility would allow better assessment of the ability of liver parenchyma to tolerate further chemotherapy. Second, if resection is planned, surgical risk could be better assessed.”

To assess the reversibility of chemotherapy-associated liver injuries, the researchers reviewed the data of 429 patients who underwent liver resection with 2 or more months of oxaliplatin- and/or irinotecan-based chemotherapy preoperatively. There were 524 liver resections: 70 patients had two hepatectomies, 11 had three and one patient had four.

Ninety-eight patients had two or more lines and 270 patients had 7 or more cycles of chemotherapy. Intervals between end of chemotherapy to surgery were 90 days or less (n = 394), 91 to 180 days (n = 77), 181 to 270 days (n = 22) or over 270 days (n = 31).

Overall, 315 patients had chemotherapy-associated liver injuries, including sinusoidal dilation (n = 359), 203 of whom had grade 2 to 3; nodular generative hyperplasia (n = 101), 18 of whom had grade 2 to 3; grade 2 to 3 steatosis (n = 128); steatohepatitis (n = 55); and peliosis (n = 42).

The only significant association between chemotherapy-to-surgery intervals was a lower prevalence of grade 2 to 3 sinusoidal dilation among those with an interval over 270 days (19.4% vs. 40%; P = .022). This remained significant after multivariate analysis (OR = 0.291; 95% CI, 0.115-0.739). Data showed an association between bevacizumab administration and a lower prevalence of grade 2 to 3 sinusoidal dilation (OR = 0.53; 95% CI, 0.347-0.809).

Among the 82 patients who had repeat resections — 35 of whom had received chemotherapy between resections — researchers observed a regression of chemotherapy-associated liver injuries in three patients. All three patients had chemotherapy-to-surgery intervals over 270 days.

Of the 47 patients with multiple resection without interval chemotherapy, injuries did not change significantly in those with shorter intervals, but did change significantly in those with intervals over 270 days.

“Liver injuries do not reverse during short time intervals. These data should be considered in patients scheduled for a two-stage hepatectomy (at the second stage the same injuries will be present as were observed at the first stage) and in patients undergoing liver resection after colonic resection without chemotherapy between the two procedures,” the researchers wrote. “Finally, liver injuries may occur after oxaliplatin-based adjuvant chemotherapy for primary colorectal cancer, the first liver resection being performed when (and if) liver metastases appear; 9-month intervals are relatively common.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.