Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases
Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases
复制标题
DOI：
10.1200/jco.2006.05.8156
复制
发表时间：
2006-11-01
影响因子：
45.3
通讯作者：
Adam, Rene
中科院分区：
文献类型：
--
作者：
Aloia, Thomas;Sebagh, Mylene;Adam, Rene
目的直肠癌肝转移（CLM）术前化疗可引起非肿瘤肝（NTBL）组织学改变，影响手术效果。患者与方法从303例CLM肝切除术患者中随机抽取92例（75例术前化疗：C+组，17例初治化疗：C -组）进行详细的病理分析。术前化疗包括单独使用氟尿嘧啶(FU)/亚叶酸蛋白（23例，多数为生物钟调节）或联合奥沙利铂（52例，均为生物钟调节）。为了确定研究因素之间的关联，将临床和手术变量与病理数据和手术结果进行比较。结果尽管临床和手术因素分布相似，但C+患者术中接受红细胞输注（平均单位分别为1.9 vs 0.5, P = 0.03）和NTBL血管异常（分别为52% vs 18%， P = 0.01）的可能性高于C-患者。存在最严重形式的血管改变与红细胞输血需求密切相关（P = 0.04）。相比之下，中度至重度脂肪变性的分布相似（C组，12%；C +组，13%）。虽然围手术期死亡率和发病率在所有组中相似，但超过12个疗程的化疗相比
PurposePreoperative chemotherapy for colorectal liver metastases (CLM) can produce histologic changes in the nontumor-bearing liver (NTBL) that may impact on surgical outcomes.Patients and MethodsFrom a cohort of 303 patients treated for CLM with liver resection, 92 patients ( 75 received preoperative chemotherapy: group C+; and 17 were chemotherapy naive: group C -) were randomly selected for detailed pathologic analysis. Preoperative chemotherapy consisted of fluorouracil (FU)/ leucovorin alone ( 23 patients, the majority chronomodulated) or in combination with oxaliplatin ( 52 patients, all chronomodulated). To determine associations between study factors, clinical and operative variables were compared with pathology data and surgical outcomes.ResultsAlthough clinical and operative factors were similarly distributed, C+ patients, compared with C- patients, were more likely to receive intraoperative RBC transfusions ( mean units: 1.9 v 0.5, respectively; P =.03) and to have vascular abnormalities in the NTBL (52% v 18%, respectively; P =.01). Presence of the most severe forms of vascular alterations was closely associated with RBC transfusion requirements ( P =.04). In contrast, moderate to severe steatosis was similarly distributed ( C - group, 12%; C + group, 13%). Although perioperative mortality and morbidity rates were similar in all groups, more than 12 courses of chemotherapy, compared with