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首页> 外文期刊>Journal of Clinical Oncology >Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases.
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Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases.

机译：术前用氟尿嘧啶加奥沙利铂化疗的结直肠癌肝转移患者的肝组织学和手术结局。

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PURPOSE: Preoperative chemotherapy for colorectal liver metastases (CLM) can produce histologic changes in the nontumor-bearing liver (NTBL) that may impact on surgical outcomes. PATIENTS AND METHODS: From 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. RESULTS: Although 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 < or = 12 courses, predisposed patients to reoperation (11% v 0%, respectively; P = .04) and to longer hospitalization (15 v 11 days, respectively; P = .02). CONCLUSION: The main hepatic lesion induced by preoperative FU/oxaliplatin chemotherapy in patients with CLM is vascular and not steatosis. Detailed pathologic analysis determined that the most severe vascular lesions are associated with increased intraoperative transfusions. The risk for other postoperative complications is related to the duration of preoperative chemotherapy administration.
机译：目的：大肠肝转移术（CLM）的术前化学疗法可在非肿瘤肝（NTBL）中产生组织学变化，这可能会影响手术效果。患者与方法：从303例接受CLM肝切除治疗的患者队列中，随机选择了92例患者（其中75例接受了术前化学治疗：C +组; 17例接受了单纯化疗：C-组）以进行详细的病理分析。术前化疗仅由氟尿嘧啶（FU）/亚叶酸钙组成（23例，多数为经时控）或与奥沙利铂联合治疗（52例，均为经时控）。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的分布相似，但与C型患者相比，C +患者更容易接受术中RBC输血（平均单位：1.9 v 0.5; P = .03），并且在术中出现血管异常NTBL（分别为52％对18％; P = 0.01）。最严重形式的血管改变的存在与RBC输血需求密切相关（P = .04）。相反，中度至重度脂肪变性的分布相似（C-组为12％; C +组为13％）。尽管所有组的围手术期死亡率和发病率均相似，但超过12个疗程的化学疗法（<或= 12个疗程）易使患者再次手术（分别为11％v 0％; P = .04）和更长的住院时间（分别为15天和11天; P = .02）。结论：术前FU /奥沙利铂化疗引起的CLM患者的主要肝病变是血管性而非脂肪变性。详细的病理分析确定，最严重的血管病变与术中输血增加有关。其他术后并发症的风险与术前化疗的持续时间有关。

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