Abstract
Introduction
Recently, there has been increasing interest in the preoperative prediction and prevention
of post-hepatectomy liver failure (PHLF). This is a particular concern in colorectal
liver metastases (CRLM), when surgery follows potentially hepatotoxic chemotherapy.
Platelet-based liver scores (PBLS) such as APRI and FIB-4 are predictive of chemotherapy-associated
liver injury (CALI) and PHLF. Estimation of the future liver remnant function (eFLRF)
by combining 99mTc-Mebrofenin Hepatobiliary Scintigraphy (HBSBSA) with future liver remnant volume ratio (FLRV%), is predictive of PHLF and related
mortality. We hypothesized that a HBSBSA based formula was a better predictor for PHLF than PBLS in chemotherapy-pretreated
CRLM.
Methods
Between 2012 and 2016, 140 patients underwent liver resection for CRLM following systemic
therapy. HBSBSA, FLRV%, eFLRF and PBLS were calculated and compared for their value in predicting
PHLF.
Results
eFLRF and FLRV% had a better predictive value for PHLF than HBSBSA alone and APRI and FIB-4 (AUC = 0.800, 0.843 versus 0.652, 0.635 and 0.658 respectively).
In a subgroup analysis (Oxaliplatin all, Oxaliplatin ≥ 6 cycles, Irinotecan all and
Irinotecan ≥ 6 cycles), eFLRF was the only factor predictive for PHLF in all subgroups
(all: p ≤ 0.05). Prediction of HBSBSA for chemotherapy associated steato-hepatitis (CASH) reached almost significance (p = 0.06).
FIB-4 was predictive for sinusoidal obstruction syndrome (SOS) (p = 0.011). Only weak
correlation was found between HBSBSA and PBLS.
Conclusion
eFLRF is a better predictor of PHLF than PBLS or HBSBSA alone. PBLS seem to measure other aspects of liver function or damage than HBSBSA.
Keywords
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References
- Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer.Ann Oncol. 2004; 15: 460-466
- Liver failure in patients treated with chemotherapy for colorectal liver metastases: role of chronic disease scores in patients undergoing major liver surgery. A case-matched analysis.Eur J Surg Oncol. 2014; 40: 1550-1556
- Preoperative assessment of postoperative remnant liver function using hepatobiliary scintigraphy.J Nucl Med. 2004; 45: 965-971
- Preoperative assessment of liver function: a comparison of 99mTc-Mebrofenin scintigraphy with indocyanine green clearance test.Liver Int. 2004; 24: 117-123
- Future remnant liver function estimated by combining liver volumetry on magnetic resonance imaging with total liver function on (99m)Tc-mebrofenin hepatobiliary scintigraphy: can this tool predict post-hepatectomy liver failure?.HPB (Oxf). 2016; 18: 494-503
- Measuring future liver remnant function prior to hepatectomy may guide the indication for portal vein occlusion and avoid posthepatectomy liver failure: a prospective interventional study.HPB (Oxf). 2017; 19: 108-117
- IODIDA clearance rate: a method for measuring hepatocyte uptake function.Transpl Proc. 1992; 24: 387-388
- Hepatic sinusoidal obstruction syndrome (SOS) reduces the effect of oxaliplatin in colorectal liver metastases.Histopathology. 2012; 61: 314-318
- Posthepatectomy liver failure: a definition and grading by the international study group of liver surgery (ISGLS).Surgery. 2011; 149: 713-724
- Optimal future liver remnant in patients treated with extensive preoperative chemotherapy for colorectal liver metastases.Ann Surg Oncol. 2013; 20: 2493-2500
- Preoperative chemotherapy and the risk of hepatotoxicity and morbidity after liver resection for metastatic colorectal cancer: a single institution experience.J Am Coll Surg. 2013; 216: 41-49
- Kinetic changes in liver parenchyma after preoperative chemotherapy for patients with colorectal liver metastases.J Gastrointest Surg. 2017; 21: 813-821
- Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases.J Clin Oncol. 2006; 24: 2065-2072
- Chemotherapy-associated liver injury in patients with colorectal liver metastases: a systematic review and meta-analysis.Ann Surg Oncol. 2012; 19: 4287-4299
- Sinusoidal injury increases morbidity after major hepatectomy in patients with colorectal liver metastases receiving preoperative chemotherapy.Ann Surg. 2008; 247: 118-124
- Extended preoperative chemotherapy does not improve pathologic response and increases postoperative liver insufficiency after hepatic resection for colorectal liver metastases.Ann Surg Oncol. 2010; 17: 2870-2876
- A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C.Hepatology. 2003; 38: 518-526
- Preoperative aspartate aminotransferase-to-platelet ratio index (APRI) is a predictor on postoperative outcomes of hepatocellular carcinoma.Med (Baltim). 2016; 95e5486
- Predicting high grade lesions of sinusoidal obstruction syndrome related to oxaliplatin-based chemotherapy for colorectal liver metastases: correlation with post-hepatectomy outcome.Ann Surg. 2010; 251: 454-460
- Nodular regenerative hyperplasia in patients undergoing liver resection for colorectal metastases after chemotherapy: risk factors, preoperative assessment and clinical impact.Ann Surg Oncol. 2015; 22: 4149-4157
- Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection.Hepatology. 2006; 43: 1317-1325
- FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest.Hepatology. 2007; 46: 32-36
- The FIB-4 score predicts postoperative short-term outcomes of hepatocellular carcinoma fulfilling the Milan criteria.Eur J Surg Oncol. 2016; 42: 722-727
- Sinusoidal obstruction syndrome (SOS) related to chemotherapy for colorectal liver metastases: factors predictive of severe SOS lesions and protective effect of bevacizumab.HPB. 2013; 15: 858-864
- Technetium-99m-iminodiacetic acid organic anions: review of biokinetics and clinical application in hepatology.Hepatology. 1989; 9: 139-153
- Assessment of future remnant liver function using hepatobiliary scintigraphy in patients undergoing major liver resection.J Gastrointest Surg. 2010; 14: 369-378
- Risk assessment of posthepatectomy liver failure using hepatobiliary scintigraphy and CT volumetry.J Nucl Med. 2007; 48: 685-692
- 99mTc-GSA scintigraphy with SPECT for assessment of hepatic function and functional volume during liver regeneration in a rat model of partial hepatectomy.J Nucl Med. 2008; 49: 122-128
- (99m)Tc-mebrofenin hepatobiliary scintigraphy with SPECT for the assessment of hepatic function and liver functional volume before partial hepatectomy.J Nucl Med. 2010; 51: 229-236
- Measurement of liver function using hepatobiliary scintigraphy improves risk assessment in patients undergoing major liver resection.HPB (Oxf). 2016; 18: 773-780
Article info
Publication history
Published online: September 04, 2017
Accepted:
August 10,
2017
Identification
Copyright
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
