Liver surface nodularity: a novel predictor of post-hepatectomy liver failure in patients with colorectal liver metastases following chemotherapy
Liver surface nodularity: a novel predictor of post-hepatectomy liver failure in patients with colorectal liver metastases following chemotherapy
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肝脏表面结节：化疗后结直肠肝转移患者肝切除术后肝功能衰竭的新预测因子
DOI：
10.1007/s00330-020-07683-y
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Ronot M.
中科院分区：
文献类型：
--
作者：
Yoh T;Perrot A;Beaufrere A;Hobeika C;Sartoris R;Paradis V;Vilgrain V;Soubrane O;Cauchy F;Ronot M.
目的探讨肝表面结节、化疗相关性肝损伤(CALI)与肝切除术后肝功能衰竭(≥B级)的关系。方法回顾分析2010年至2017年间因肝转移行化疗后肝切除患者的术前CT表现。在肝切除术前6周内有可用的CT扫描的患者使用半自动CT软件CT图像测量LSN，并根据两位腹部放射科医生同意的1~10次测量的平均值计算LSN。结果分析了256例患者(男性149例，女性107例；总体中位年龄61岁，范围29-88岁)。26例(10.2%)患者发生CR-PHLF。经受试者工作特性分析(p<；0.001)确定，检测CR-PHLFLN的最佳界值为2.5.LSN≥2.5与延长化疗周期有关(P=0.018)，但与CALIS无关。在倾向性评分匹配后，LSN与CR-PHLF值显著相关(p=0.031)。此外，多变量分析确定LSNPHLF2.50和未来肝残留量(≥)和30%是102例接受大范围肝切除术的患者术前预测CR-PHLF值的重要指标。LSNPHLF2.50在接受大手术的患者中发生率更高，尽管FLRPHLF30%(p=0.008)。结论在接受化疗后行肝切除的患者中，CT上定量的LSNPHLF值是CR-≥的一个独立的替代指标，可以为这些患者的术前评估提供有价值的补充工具。·高LSN值是行肝大部切除术患者术后临床相关肝功能衰竭的独立预测因子。·LSN值≥2.50在肝大部切除患者中更常见，尽管未来的肝脏残留≥为30%。
ObjectivesThe goal of this study was to assess the relationship between liver surface nodularity (LSN), chemotherapy-associated liver injury (CALI), and clinically relevant post-hepatectomy liver failure (CR-PHLF) (i.e., ≥ grade B) in patients undergoing hepatectomy for colorectal liver metastases (CLM).MethodsPreoperative CT scans of patients who underwent chemotherapy followed by hepatectomy for CLM between 2010 and 2017 were retrospectively analyzed. LSN was measured using semi-automated CT software CT images in patients who had available preoperative CT scans within 6 weeks before hepatectomy, and was computed based on the means of one to 10 measurements by two abdominal radiologists consensually. The association of LSN, CALI, and CR-PHLF was analyzed.ResultsTwo hundred fifty-six patients were analyzed (149 men and 107 women; overall median age, 61 [range, 29–88 years]). A total of 26 patients (10.2%) developed CR-PHLF. The optimal LSN cut-off value for detecting CR-PHLF was 2.5, as determined by receiver operative characteristic analysis (p< 0.001). LSN ≥ 2.5 was associated with prolonged chemotherapy (> 6 cycles,p= 0.018), but not with CALIs. After propensity score matching, LSN remained significantly associated with CR-PHLF (p= 0.031). Furthermore, multivariate analysis identified LSN ≥ 2.50 and future liver remnant (FLR) < 30% as significant preoperative predictors of CR-PHLF in 102 patients undergoing major hepatectomy. LSN ≥ 2.50 was more frequent in patients undergoing major hepatectomy despite FLR ≥ 30% (p= 0.008).ConclusionLSN quantified on CT is an independent surrogate of CR-PHLF in patients who undergo chemotherapy followed by hepatectomy for CLM and may provide a valuable additional tool in the preoperative assessment of these patients.Key Points• LSN was not associated with chemotherapy- associated liver injury but high LSN (defined ≥ 2.5) was associated with prolonged chemotherapy (> 6 cycles).• High LSN was an independent predictor of clinically relevant postoperative liver failure in patients undergoing hepatectomy for CRLM.• LSN ≥ 2.50 was more frequent in patients with PHLF after major hepatectomy despite a future liver remnant ≥ 30%.
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影响因子：
9.6
作者：
Hobeika, C.;Cauchy, F.;Soubrane, O.
通讯作者：
Soubrane, O.
影响因子：
19.7
作者：
Sartoris, Riccardo;Rautou, Pierre-Emmanuel;Ronot, Maxime
通讯作者：
Ronot, Maxime
术前化疗后的肝萎缩预示着结直肠肝转移瘤切除后的肝功能不全。
影响因子：
25.7
作者：
S. Yamashita;J. Shindoh;Takashi Mizuno;Y. Chun;C. Conrad;T. Aloia;J. Vauthey
通讯作者：
J. Vauthey
影响因子：
45.3
作者：
Overman, Michael J.;Maru, Dipen M.;Kopetz, Scott
通讯作者：
Kopetz, Scott
我们能否将化疗引起的肝损伤从病理学转移到临床？
影响因子：
25.7
作者：
J. Vauthey;Takashi Mizuno;M. Overman;O. Soubrane
通讯作者：
O. Soubrane