The association between preoperative chemotherapy and the prevalence of hepatic steatosis in hepatectomy for metastatic colorectal cancer

BACKGROUND: Some studies have suggested that preoperative chemotherapy for hepatic colorectal metastases may cause hepatic injury and increase perioperative morbidity and mortality. AIM: To evaluate the prevalence of hepatic steatosis in patients undergoing preoperative chemotherapy for metastatic colorectal cancer. METHODS: Observational retrospective cohort study in which 166 patients underwent 185 hepatectomies for metastatic colorectal cancer with or without associated preoperative chemotherapy from 2004 to 2011. The data were obtained from a review of the medical records and an analysis of the anatomopathological report on the non-tumor portion of the surgical specimen. The study sample was divided into two groups: those who were exposed and those who were unexposed to chemotherapy. RESULTS: From the hepatectomies, 136 cases (73.5%) underwent preoperative chemotherapy, with most (62.5%) using a regimen of 5-fluorouracil + leucovorin. A 40% greater risk of cell damage was detected in 62% of the exposed group. The predominant histological pattern of the cell damage was steatosis, which was detected in 51% of the exposed cases. Exposure to chemotherapy increased the risk of steatosis by 2.2 fold. However, when the risk factors were controlled, only the presence of risk of hepatopathy was associated with steatosis, with a relative risk of 4 (2.7-5.9). CONCLUSION: Patients exposed to chemotherapy have 2.2 times the risk of developing hepatic steatosis, and its occurrence is associated with the presence of predisposing factors such as diabetes mellitus and hepatopathy.

背景：已有研究表明，针对结直肠癌肝转移的术前化疗可能引发肝损伤，并增加围手术期并发症发生率与死亡率。
目的：评估转移性结直肠癌患者接受术前化疗后肝脂肪变性（hepatic steatosis）的患病率。
方法：本研究为观察性回顾性队列研究，纳入2004年至2011年间166例因转移性结直肠癌接受185次肝切除术的患者，这些患者术前伴或不伴术前化疗。研究数据通过查阅患者病历档案，以及对手术标本非肿瘤组织的解剖病理报告分析获取。研究队列分为化疗暴露组与未暴露组两类。
结果：本次研究涉及的肝切除手术中，136例（73.5%）患者接受了术前化疗，其中多数（62.5%）采用5-氟尿嘧啶（5-fluorouracil）+亚叶酸钙（leucovorin）的化疗方案。化疗暴露组中有62%的患者被检出细胞损伤风险较基线升高40%。该类细胞损伤的主要组织学类型为肝脂肪变性，在暴露组中检出率达51%。化疗暴露使肝脂肪变性的发病风险升高2.2倍。然而，在控制混杂危险因素后，仅肝病风险因素与肝脂肪变性存在关联，其相对风险为4（95%置信区间：2.7-5.9）。
结论：接受术前化疗的患者发生肝脂肪变性的风险为未接受化疗患者的2.2倍，且该病的发生与糖尿病、肝病等易感因素存在关联。