Biliary Sclerosis after Hepatic Arterial Infusion Pump Chemotherapy for Patients with Colorectal Cancer Liver Metastasis: Incidence, Clinical Features, and Risk Factors
Biliary Sclerosis after Hepatic Arterial Infusion Pump Chemotherapy for Patients with Colorectal Cancer Liver Metastasis: Incidence, Clinical Features, and Risk Factors
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DOI：
10.1245/s10434-011-2102-8
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发表时间：
2012-05-01
影响因子：
3.7
通讯作者：
D'Angelica, Michael I.
中科院分区：
文献类型：
--
作者：
Ito, Kaori;Ito, Hiromichi;D'Angelica, Michael I.
肝动脉灌注泵化疗（HAIPC）有助于延长结直肠癌肝转移（CRCLM）患者的生存期。HAIPC联合阿糖胞苷（FUDR）治疗后最重要的临床不良事件是胆道硬化（BS）。我们对1991年至2008年连续475例接受HAIPC治疗的患者进行了HAIPC治疗。审查了发病率、临床特征、与人口统计学相关的变量、合并症、病史、CRCLM、手术、化疗和实验室数据。对可能与BS相关的因素进行了分析，定义为与HAIPC相关的需要支架置入的胆道狭窄，在接受HAIPC作为肝切除术后辅助治疗的患者中BS的发生率为5.5%（16/293），在接受HAIPC和FUDR治疗不可切除疾病的患者中BS的发生率为2%（2/100）。肝总管是最常见的受累部位（87.5%）。在接受辅助HAIPC的患者中，BS与术后血流扫描异常（18.8% vs. 1.8%，P = 0.006）、术后感染并发症（50.0% vs. 14.8%，P = 0.002）和FUDR剂量/周期/体重（2.6 vs. 2.0 mg/周期/kg，P = 0.025）相关。没有患者直接死于BS。中位生存期不受BS发展的影响（BS与非BS：分别为61.0个月[范围6.2-171.6个月]与47.2个月[范围2.4-200.8个月]，P = 0.316）。BS是HAIPC后的一种罕见并发症，如果通过支架植入或扩张充分挽救，则不影响生存期。手术并发症以及动脉内化疗的类型和剂量可能有助于BS的发展。
Hepatic arterial infusion pump chemotherapy (HAIPC) contributes to the prolonged survival of selected patients with colorectal cancer liver metastases (CRCLM). The most clinically important adverse event after HAIPC with floxuridine (FUDR) is biliary sclerosis (BS). Little is known about the etiology of BS.HAIPC was administered to 475 consecutive patients who received HAIPC on prospective protocols from 1991 to 2008. The incidence, clinical features, variables related to demographics, comorbidity, medical history, CRCLM, surgery, chemotherapy, and laboratory data were reviewed. An analysis of factors potentially associated with BS, defined as a biliary stricture related to HAIPC requiring stent placement, was performed.The incidence of BS was 5.5% (16 of 293) in patients receiving HAIPC as an adjuvant therapy after hepatectomy, and 2% (2 of 100) in patients receiving HAIPC with FUDR for unresectable disease. The common hepatic duct was the site most frequently affected (87.5%). In patients receiving adjuvant HAIPC, BS was associated with abnormal postoperative flow scans (18.8% vs. 1.8%, P = 0.006), postoperative infectious complications (50.0% vs. 14.8%, P = 0.002), and larger dose/cycle/weight of FUDR (2.6 vs. 2.0 mg/cycle/kg, P = 0.025) than patients without BS. No patient died directly of BS. Median survival was not compromised by the development of BS (BS vs. non-BS: 61.0 months [range 6.2-171.6 months] vs. 47.2 months [range 2.4-200.8 months], P = 0.316, respectively).BS is an uncommon complication after HAIPC and does not compromise survival if adequately salvaged by stenting or dilatation. Surgical complications as well as type and dose of intra-arterial chemotherapy may contribute to the development of BS.