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Becerra-Tomás N, Markozannes G, Cariolou M, Balducci K, Vieira R, Kiss S, Aune D, Greenwood DC, Dossus L, Copson E, Renehan AG, Bours M, Demark-Wahnefried W, Hudson MM, May AM, Odedina FT, Skinner R, Steindorf K, Tjønneland A, Velikova G, Baskin ML, Chowdhury R, Hill L, Lewis SJ, Seidell J, Weijenberg MP, Krebs J, Cross AJ, Tsilidis KK, Chan DSM. Post-diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer 2024; 155:400-425. [PMID: 38692659 DOI: 10.1002/ijc.34905] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/15/2023] [Accepted: 01/17/2024] [Indexed: 05/03/2024]
Abstract
The adiposity influence on colorectal cancer prognosis remains poorly characterised. We performed a systematic review and meta-analysis on post-diagnosis adiposity measures (body mass index [BMI], waist circumference, waist-to-hip ratio, weight) or their changes and colorectal cancer outcomes. PubMed and Embase were searched through 28 February 2022. Random-effects meta-analyses were conducted when at least three studies had sufficient information. The quality of evidence was interpreted and graded by the Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel. We reviewed 124 observational studies (85 publications). Meta-analyses were possible for BMI and all-cause mortality, colorectal cancer-specific mortality, and cancer recurrence/disease-free survival. Non-linear meta-analysis indicated a reverse J-shaped association between BMI and colorectal cancer outcomes (nadir at BMI 28 kg/m2). The highest risk, relative to the nadir, was observed at both ends of the BMI distribution (18 and 38 kg/m2), namely 60% and 23% higher risk for all-cause mortality; 95% and 26% for colorectal cancer-specific mortality; and 37% and 24% for cancer recurrence/disease-free survival, respectively. The higher risk with low BMI was attenuated in secondary analyses of RCTs (compared to cohort studies), among studies with longer follow-up, and in women suggesting potential methodological limitations and/or altered physiological state. Descriptively synthesised studies on other adiposity-outcome associations of interest were limited in number and methodological quality. All the associations were graded as limited (likelihood of causality: no conclusion) due to potential methodological limitations (reverse causation, confounding, selection bias). Additional well-designed observational studies and interventional trials are needed to provide further clarification.
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Affiliation(s)
- Nerea Becerra-Tomás
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Margarita Cariolou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Katia Balducci
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sonia Kiss
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Oslo New University College, Oslo, Norway
- Department of Research, The Cancer Registry of Norway, Oslo, Norway
| | - Darren C Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Laure Dossus
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Ellen Copson
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew G Renehan
- The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Martijn Bours
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Cancer and Health, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Galina Velikova
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | - Rajiv Chowdhury
- Department of Global Health, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Lynette Hill
- World Cancer Research Fund International, London, UK
| | - Sarah J Lewis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jaap Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - John Krebs
- Department of Biology, University of Oxford, Oxford, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Doris S M Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Peloso A, Tihy M, Moeckli B, Rubbia-Brandt L, Toso C. Clearing Steatosis Prior to Liver Surgery for Colorectal Metastasis: A Narrative Review and Case Illustration. Nutrients 2022; 14:5340. [PMID: 36558499 PMCID: PMC9785595 DOI: 10.3390/nu14245340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Over recent years, non-alcoholic fatty liver disease (NAFLD) has become the most common liver disorder in the developed world, accounting for 20% to 46% of liver abnormalities. Steatosis is the hallmark of NAFLD and is recognized as an important risk factor for complication and death after general surgery, even more so after liver resection. Similarly, liver steatosis also impacts the safety of live liver donation and transplantation. We aim to review surgical outcomes after liver resection for colorectal metastases in patients with steatosis and discuss the most common pre-operative strategies to reduce steatosis. Finally, as illustration, we report the favorable effect of a low-caloric, hyper-protein diet during a two-stage liver resection for colorectal metastases in a patient with severe steatosis.
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Affiliation(s)
- Andrea Peloso
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
| | - Matthieu Tihy
- Department of Pathology and Immunology, University of Geneva, 1205 Geneva, Switzerland
- Division of Clinical Pathology, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Beat Moeckli
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Department of Pathology and Immunology, University of Geneva, 1205 Geneva, Switzerland
- Division of Clinical Pathology, Geneva University Hospital, 1205 Geneva, Switzerland
| | - Christian Toso
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
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O'Connell RM, O'Neill M, Ó Ríordáin MG, Ó Súilleabháin CB, O'Sullivan AW. Sarcopaenia, obesity, sarcopaenic obesity and outcomes following hepatic resection for colorectal liver metastases: a systematic review and meta-analysis. HPB (Oxford) 2022; 24:1844-1853. [PMID: 35922276 DOI: 10.1016/j.hpb.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obesity is a risk factor for the development of colorectal cancer. Limited evidence exists about outcomes for obese patients undergoing hepatic resection for colorectal liver metastases (CRLM). Sarcopaenia is characterised by a decline in muscle function and muscle mass. It is associated with poorer outcomes for patients on chemotherapy, but there are limited data for sarcopaenic patients undergoing hepatic resection for CRLM. METHODS Pubmed, Embase, Cochrane Central, Web of Science, SCOPUS, and CINAHL databases were searched for articles which were selected in accordance with PRISMA guidelines. Primary outcomes were overall survival (OS) and disease-free survival (DFS). A random effects meta-analysis was conducted. RESULTS Thirteen studies were included incorporating 2936 patients. No significant difference was found between obese and non-obese patients in OS (HR 0.81, CI 0.47-1.39, p = 0.44) or DFS (HR 1.0, CI 0.99-1.01, p = 0.98). Sarcopaenia was associated with worse OS (HR 1.65, CI 1.10-2.48, p = 0.01), and increased major post operative complications (OR 1.91, CI 1.16-3.14, p = 0.01). Only one study examined outcomes for sarcopaenic obese patients. CONCLUSION Limited evidence exists describing the impact of obesity and sarcopenia on outcomes following hepatic resection for CRLM. Obese patients do not have worse oncological outcomes, whereas sarcopaenia is associated with poorer long-term survival.
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Affiliation(s)
- Robert M O'Connell
- Department of Hepatopancreatobiliary Surgery, Mercy University Hospital, Cork, Ireland.
| | - Maeve O'Neill
- Department of Colorectal Surgery, Mercy University Hospital, Cork, Ireland
| | | | | | - Adrian W O'Sullivan
- Department of Hepatopancreatobiliary Surgery, Mercy University Hospital, Cork, Ireland
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Liu W, Chen FL, Wang K, Bao Q, Wang HW, Jin KM, Xing BC. Irinotecan- vs oxaliplatin-based regimens for neoadjuvant chemotherapy in colorectal liver metastasis patients: A retrospective study. World J Gastrointest Surg 2022; 14:904-917. [PMID: 36185567 PMCID: PMC9521480 DOI: 10.4240/wjgs.v14.i9.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/28/2022] [Accepted: 08/26/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NC) improves the survival outcomes of selected patients with colorectal liver metastasis (CRLM). The benefits of irinotecan-based regimens in these patients are still under debate.
AIM To compare the benefits of irinotecan- and oxaliplatin-based regimens in patients with resectable CRLM.
METHODS From September 2003 to August 2020, 554 patients received NC and underwent hepatectomy for CRLM. Based on a 1:1 propensity score matching (PSM) model, 175 patients who received irinotecan were matched to 175 patients who received oxaliplatin to obtain two balanced groups regarding demographic, therapeutic, and prognostic characteristics.
RESULTS Chemotherapy was based on oxaliplatin in 353 (63.7%) patients and irinotecan in 201 (36.3%). After PSM, the 5-year progression-free survival (PFS) and overall survival (OS) rates with irinotecan were 18.0% and 49.7%, respectively, while the 5-year PFS and OS rates with oxaliplatin were 26.0% and 46.8%, respectively. Intraoperative blood loss, operating time, and postoperative complications differed significantly between the two groups. In the multivariable analysis, carbohydrate antigen 19-9, RAS mutation, response to NC, tumor size > 5 cm, and tumor number > 1 were independently associated with PFS.
CONCLUSION In NC in patients with CRLM, irinotecan is similar to oxaliplatin in survival outcomes, but irinotecan is superior regarding operating time, intraoperative blood loss, and postoperative complications.
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Affiliation(s)
- Wei Liu
- Department of Hepatopancreatobiliary Surgery, Peking University School of Oncology, Beijing Cancer Hospital, Beijing 100142, China
| | - Feng-Lin Chen
- Department of Hepatopancreatobiliary Surgery, Peking University School of Oncology, Beijing Cancer Hospital, Beijing 100142, China
| | - Kun Wang
- Department of Hepatopancreatobiliary Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China
| | - Quan Bao
- Department of Hepatopancreatobiliary Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China
| | - Hong-Wei Wang
- Department of Hepatopancreatobiliary Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China
| | - Ke-Min Jin
- Department of Hepatopancreatobiliary Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China
| | - Bao-Cai Xing
- Department of Hepatopancreatobiliary Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China
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Krasnodębski M, Morawski M, Borkowski J, Grąt K, Stypułkowski J, Skalski M, Zhylko A, Krawczyk M, Grąt M. Skin Autofluorescence Measurement as Initial Assessment of Hepatic Parenchyma Quality in Patients Undergoing Liver Resection. J Clin Med 2022; 11:5341. [PMID: 36142988 PMCID: PMC9503381 DOI: 10.3390/jcm11185341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/01/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Skin autofluorescence (SAF) can detect advanced glycation end products (AGEs) that accumulate in tissues over time. AGEs reflect patients’ general health, and their pathological accumulation has been associated with various diseases. This study aimed to determine whether its measurements can correlate with the liver parenchyma quality. This prospective study included 186 patients who underwent liver resections. Liver fibrosis and/or steatosis > 10% were found in almost 30% of the patients. ROC analysis for SAF revealed the optimal cutoff point of 2.4 AU as an independent predictor for macrovesicular steatosis ≥ 10% with an AUC of 0.629 (95% CI 0.538−0.721, p = 0.006), 59.9% sensitivity, 62.4% specificity, and positive (PPV) and negative (NPV) predictive values of 45.7% and 74.1%, respectively. The optimal cutoff point for liver fibrosis was 2.3 AU with an AUC of 0.613 (95% CI 0.519−0.708, p = 0.018), 67.3% sensitivity, 55.2% specificity, and PPV and NPV of 37.1% and 81.2%, respectively. In the multivariable logistic regression model, SAF ≥ 2.4 AU (OR 2.16; 95% CI 1.05−4.43; p = 0.036) and BMI (OR 1.21; 95% CI 1.10−1.33, p < 0.001) were independent predictors of macrovesicular steatosis ≥ 10%. SAF may enhance the available non-invasive methods of detecting hepatic steatosis and fibrosis in patients prior to liver resection.
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Affiliation(s)
- Maciej Krasnodębski
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Marcin Morawski
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Jan Borkowski
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Karolina Grąt
- Second Department of Clinical Radiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Jan Stypułkowski
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Michał Skalski
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Andriy Zhylko
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Marek Krawczyk
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Michał Grąt
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland
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Yang S, Peng R, Zhou L. The impact of hepatic steatosis on outcomes of colorectal cancer patients with liver metastases: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:938718. [PMID: 36160137 PMCID: PMC9498207 DOI: 10.3389/fmed.2022.938718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/11/2022] [Indexed: 12/24/2022] Open
Abstract
Background It is unclear how hepatic steatosis impacts patient prognosis in the case of colorectal cancer with liver metastases (CRLM). The purpose of this review was to assess the effect of hepatic steatosis on patient survival and disease-free survival (DFS) in the case of CRLM. Methods We examined the databases of PubMed, CENTRAL, Embase, Google Scholar, and ScienceDirect for studies reporting outcomes of CRLM patients with and without hepatic steatosis. We performed a random-effects meta-analysis using multivariable adjusted hazard ratios (HR). Results Nine studies reporting data of a total of 14,197 patients were included. All patients had undergone surgical intervention. Pooled analysis of seven studies indicated that hepatic steatosis had no statistically significant impact on patient survival in CRLM (HR: 0.92 95% CI: 0.82, 1.04, I2 = 82%, p = 0.18). Specifically, we noted that there was a statistically significant improvement in cancer-specific survival amongst patients with hepatic steatosis (two studies; HR: 0.85 95% CI: 0.76, 0.95, I2 = 41%, p = 0.005) while there was no difference in overall survival (five studies; HR: 0.97 95% CI: 0.83, 1.13, I2 = 78%, p = 0.68). On meta-analysis of four studies, we noted that the presence of hepatic steatosis resulted in statistically significant reduced DFS in patients with CRLM (HR: 1.32 95% CI: 1.08, 1.62, I2 = 67%, p = 0.007). Conclusion The presence of hepatic steatosis may not influence patient survival in CRLM. However, scarce data is suggestive of poor DFS in CRLM patients with hepatic steatosis. Further prospective studies taking into account different confounding variables are needed to better assess the effect of hepatic steatosis on outcomes of CRLM. Systematic review registration [https://www.crd.york.ac.uk/prospero/#searchadvanced], identifier [CRD42022320665].
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Gawdi R, Valenzuela CD, Moaven O, Stauffer JA, Del Piccolo NR, Cheung T, Corvera CU, Wisneski AD, Cha C, Shen P, Russell G, Zarandi N, Dourado J. Perioperative chemotherapy for resectable colorectal liver metastases: Analysis from the Colorectal Operative Liver Metastases International Collaborative (COLOMIC). J Surg Oncol 2022; 126:339-347. [DOI: 10.1002/jso.26893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/03/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Rohin Gawdi
- Department of Surgical Oncology Comprehensive Cancer Center, Wake Forest Baptist Medical Center Winston‐Salem North Carolina USA
| | - Cristian D. Valenzuela
- Department of Surgical Oncology Comprehensive Cancer Center, Wake Forest Baptist Medical Center Winston‐Salem North Carolina USA
| | - Omeed Moaven
- Department of Surgery Mayo Clinic Jacksonville Florida USA
| | | | | | - Tanto Cheung
- Department of Surgery University of Hong Kong, Hong Kong Special Administrative Region Hong Kong China
| | - Carlos U. Corvera
- Department of Surgery University of California San Francisco San Francisco California USA
| | - Andrew D. Wisneski
- Department of Surgery University of California San Francisco San Francisco California USA
| | - Charles Cha
- Yale Department of Surgery New Haven Connecticut USA
| | - Perry Shen
- Department of Surgical Oncology Comprehensive Cancer Center, Wake Forest Baptist Medical Center Winston‐Salem North Carolina USA
| | - Greg Russell
- Department of Biostatistical Sciences Wake Forest School of Medicine Winston‐Salem North Carolina USA
| | - Nima Zarandi
- Department of Surgical Oncology Comprehensive Cancer Center, Wake Forest Baptist Medical Center Winston‐Salem North Carolina USA
| | - Justin Dourado
- Department of Surgical Oncology Comprehensive Cancer Center, Wake Forest Baptist Medical Center Winston‐Salem North Carolina USA
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Bai L, Yan XL, Lu YX, Meng Q, Rong YM, Ye LF, Pan ZZ, Xing BC, Wang DS. Circulating Lipid- and Inflammation-Based Risk (CLIR) Score: A Promising New Model for Predicting Outcomes in Complete Colorectal Liver Metastases Resection. Ann Surg Oncol 2022; 29:10.1245/s10434-021-11234-0. [PMID: 35254582 PMCID: PMC9174322 DOI: 10.1245/s10434-021-11234-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colorectal cancer liver metastasis (CRLM) is a determining factor affecting the survival of colorectal cancer (CRC) patients. This study aims at developing a novel prognostic stratification tool for CRLM resection. METHODS In this retrospective study, 666 CRC patients who underwent complete CRLM resection from two Chinese medical institutions between 2001 and 2016 were classified into the training (341 patients) and validation (325 patients) cohorts. The primary endpoint was overall survival (OS). Associations between clinicopathological variables, circulating lipid and inflammation biomarkers, and OS were explored. The five most significant prognostic factors were incorporated into the Circulating Lipid- and Inflammation-based Risk (CLIR) score. The predictive ability of the CLIR score and Fong's Clinical Risk Score (CRS) was compared by time-dependent receiver operating characteristic (ROC) analysis. RESULTS Five independent predictors associated with worse OS were identified in the training cohort: number of CRLMs >4, maximum diameter of CRLM >4.4 cm, primary lymph node-positive, serum lactate dehydrogenase (LDH) level >250.5 U/L, and serum low-density lipoprotein-cholesterol (LDL-C)/high-density lipoprotein-cholesterol (HDL-C) ratio >2.9. These predictors were included in the CLIR score and each factor was assigned one point. Median OS for the low (score 0-1)-, intermediate (score 2-3)-, and high (score 4-5)-risk groups was 134.0 months, 39.9 months, and 18.7 months in the pooled cohort. The CLIR score outperformed the Fong score with superior discriminatory capacities for OS and RFS, both in the training and validation cohorts. CONCLUSIONS The CLIR score demonstrated a promising ability to predict the long-term survival of CRC patients after complete hepatic resection.
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Affiliation(s)
- Long Bai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China
- Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, 510060, People's Republic of China
- Department of VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Xiao-Luan Yan
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), Beijing, 100142, People's Republic of China
- Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Yun-Xin Lu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China
- Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, 510060, People's Republic of China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center/Cancer Hospital, Guangzhou, People's Republic of China
| | - Qi Meng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China
- Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, 510060, People's Republic of China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center/Cancer Hospital, Guangzhou, People's Republic of China
| | - Yu-Ming Rong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China
- Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, 510060, People's Republic of China
- Department of VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Liu-Fang Ye
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China
- Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, 510060, People's Republic of China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center/Cancer Hospital, Guangzhou, People's Republic of China
| | - Zhi-Zhong Pan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China.
- Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, 510060, People's Republic of China.
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center/Cancer Hospital, Guangzhou, Guangdong, 510060, People's Republic of China.
| | - Bao-Cai Xing
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), Beijing, 100142, People's Republic of China.
- Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China.
| | - De-Shen Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China.
- Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, 510060, People's Republic of China.
- Department of Medical Oncology, Sun Yat-sen University Cancer Center/Cancer Hospital, Guangzhou, People's Republic of China.
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Han J, Zhang J, Zhang C. Irinotecan-Induced Steatohepatitis: Current Insights. Front Oncol 2021; 11:754891. [PMID: 34707997 PMCID: PMC8542761 DOI: 10.3389/fonc.2021.754891] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/23/2021] [Indexed: 01/14/2023] Open
Abstract
The hepatotoxicity of irinotecan is drawing wide concern nowadays due to the widespread use of this chemotherapeutic against various solid tumors, particularly metastatic colorectal cancer. Irinotecan-induced hepatotoxicity mainly manifests as transaminase increase and steatosis with or without transaminase increase, and is accompanied by vacuolization, and lobular inflammation. Irinotecan-induced steatohepatitis (IIS) increases the risk of morbidity and mortality in patients with colorectal cancer liver metastasis (CRCLM). The major risks and predisposing factors for IIS include high body mass index (BMI) or obesity, diabetes, and high-fat diet. Mitochondrial dysfunction and autophagy impairment may be involved in the pathogenesis of IIS. However, there is currently no effective preventive or therapeutic treatment for this condition. Thus, the precise mechanisms underlying the pathogenesis of IIS should be deciphered for the development of therapeutic drugs. This review summarizes the current knowledge and research progress on IIS.
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Affiliation(s)
- Jun Han
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Pharmacy, Affiliated Hospital of Jianghan University, Wuhan, China
| | | | - Chengliang Zhang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Fagenson AM, Pitt HA, Moten AS, Karhadkar SS, Di Carlo A, Lau KN. Fatty liver: The metabolic syndrome increases major hepatectomy mortality. Surgery 2020; 169:1054-1060. [PMID: 33358472 DOI: 10.1016/j.surg.2020.11.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/01/2020] [Accepted: 11/17/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND As the obesity epidemic worsens, the prevalence of fatty liver disease has increased. However, minimal data exist on the impact of combined fatty liver and metabolic syndrome on hepatectomy outcomes. Therefore, the aim of this analysis is to measure the outcomes of patients who do and do not have a fatty liver undergoing hepatectomy in the presence and absence of the metabolic syndrome. METHODS Patients with fatty and normal livers undergoing major hepatectomy (≥3 segments) were identified in the 2014 to 2018 American College of Surgeon National Surgical Quality Improvement Program database. Patients undergoing partial hepatectomy and those with missing liver texture data were excluded. Propensity matching was used and adjusted for multiple variables. A subgroup analysis stratified by the metabolic syndrome (body mass index ≥30 kg/m2, hypertension and diabetes) was performed. Demographics and outcomes were compared by χ2 and Mann-Whitney tests. RESULTS Of 2,927 hepatectomies, 30% of patients (N = 863) had a fatty liver. The median body mass index was 28.6, and the metabolic syndrome was present in 6.3% of patients (N = 184). After propensity matching, 863 patients with fatty and 863 with normal livers were compared. Multiple outcomes were significantly worse in patients with fatty livers (P <.05), including serious morbidity (32% vs 24%), postoperative invasive biliary procedures (15% vs 10%), organ space infections (11% vs 7.8%), and pulmonary complications. Patients with fatty livers and the metabolic syndrome had significantly increased postoperative cardiac arrests, pulmonary embolisms, and mortality (P < .05). CONCLUSION Fatty liver disease is associated with significantly worse outcomes after major hepatectomy. The metabolic syndrome confers an increased risk of postoperative mortality.
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Affiliation(s)
| | - Henry A Pitt
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Ambria S Moten
- Department of Surgery, Temple University Hospital, Philadelphia, PA
| | | | - Antonio Di Carlo
- Department of Surgery, Temple University Hospital, Philadelphia, PA
| | - Kwan N Lau
- Department of Surgery, Temple University Hospital, Philadelphia, PA.
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11
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Berardi G, Antonelli G, Colasanti M, Meniconi R, Guglielmo N, Laurenzi A, Ferretti S, Levi Sandri GB, Spagnoli A, Moschetta G, Schininà V, Antonini M, Marignani M, Ettorre GM. Association of Sarcopenia and Body Composition With Short-term Outcomes After Liver Resection for Malignant Tumors. JAMA Surg 2020; 155:e203336. [PMID: 32965483 PMCID: PMC7512123 DOI: 10.1001/jamasurg.2020.3336] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/23/2020] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Previous retrospective studies have shown that sarcopenia substantially alters the postoperative and oncological outcomes after liver resection for malignant tumors. However, the evidence is limited to small retrospective studies with heterogeneous results and the lack of standardized measurements of sarcopenia. OBJECTIVE To investigate the role of sarcopenia as a risk factor associated with 90-day morbidity after liver resection for malignant tumors. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 234 consecutive patients undergoing liver resection for malignant tumors at San Camillo Forlanini Hospital, Rome, Italy, between June 1, 2018, and December 15, 2019. Muscle mass and strength were assessed using the skeletal muscle index (SMI) on preoperative computed tomographic scans and the handgrip strength test, respectively. Patients were then divided into the following 4 groups: group A (normal muscle mass and strength), group B (reduced muscle strength), group C (reduced muscle mass), and group D (reduced muscle mass and strength). MAIN OUTCOMES AND MEASURES The primary outcome of the study was 90-day morbidity. The following secondary outcomes were investigated: 90-day mortality, hospital stay, and readmission rate. RESULTS Sixty-four major and 170 minor hepatectomies were performed in 234 patients (median age, 66.50 [interquartile range, 58.00-74.25] years; 158 men [67.5%]). The median SMI of the entire population was 46.22 (interquartile range, 38.60-58.20) cm/m2. The median handgrip strength was 30.80 (interquartile range, 22.30-36.90) kg. Patients in group D had a statistically significantly higher rate of 90-day morbidity than patients in the other groups (51.5% [35 of 68] vs 38.7% [29 of 75] in group C, 23.1% [3 of 13] in group B, and 6.4% [5 of 78] in group A; P < .001). Compared with patients in the other groups, those in group D had a longer hospital stay (10 days vs 8 days in group C, 9 days in group B, and 6 days in group A; P < .001), and more patients in this group were readmitted to the hospital (8.8% [6 of 68] vs 5.3% [4 of 75] in group C, 7.7% [1 of 13] in group B, and 0% [0 of 78] in group A; P = .02). Sarcopenia, portal hypertension, liver cirrhosis, and biliary reconstruction were independent risk factors associated with 90-day morbidity. CONCLUSIONS AND RELEVANCE Sarcopenia appears to be associated with adverse outcomes after liver resection for malignant tumors. Both muscle mass measurements on computed tomographic scans and muscle strength assessments with the handgrip strength test should be performed at the first clinical encounter to better classify patients and to minimize the risk of morbidity.
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Affiliation(s)
- Giammauro Berardi
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Giulio Antonelli
- Department of Digestive and Liver Diseases, University Sapienza, Rome, Italy
| | - Marco Colasanti
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Roberto Meniconi
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Nicola Guglielmo
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Andrea Laurenzi
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Stefano Ferretti
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Alessandra Spagnoli
- Statistics Section, Department of Public Health and Infectious Diseases, University Sapienza, Rome, Italy
| | - Giovanni Moschetta
- Department of Radiology, San Camillo Forlanini Hospital, Rome, Italy
- Department of General Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Vincenzo Schininà
- Department of Radiology, San Camillo Forlanini Hospital, Rome, Italy
| | - Mario Antonini
- Department of Radiology, San Camillo Forlanini Hospital, Rome, Italy
- Department of Anesthesiology and Intensive Care, San Camillo Forlanini Hospital, Rome, Italy
| | - Massimo Marignani
- Department of Digestive and Liver Diseases, University Sapienza, Rome, Italy
| | - Giuseppe Maria Ettorre
- Department of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
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12
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Hepatic steatosis in patients undergoing resection of colorectal liver metastases: A target for prehabilitation? A narrative review. Surg Oncol 2019; 30:147-158. [PMID: 31471139 DOI: 10.1016/j.suronc.2019.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 06/20/2019] [Accepted: 07/22/2019] [Indexed: 12/16/2022]
Abstract
The prevalence of elevated intra-hepatic fat (IHF) is increasing in the Western world, either alone as hepatic steatosis (HS) or in conjunction with inflammation (steatohepatitis). These changes to the hepatic parenchyma are an independent risk factor for post-operative morbidity following liver resection for colorectal liver metastases (CRLM). As elevated IHF and colorectal malignancy share similar risk factors for development it is unsurprisingly frequent in this cohort. In patients undergoing resection IHF may be elevated due to excess adiposity or its elevation may be induced by neoadjuvant chemotherapy, termed chemotherapy associated steatosis (CAS). Additionally, chemotherapy is implicated in the development of inflammation termed chemotherapy associated steatohepatitis (CASH). Following cessation of chemotherapy, patients awaiting resection have a 4-6 week washout period prior to resection that is a window for prehabilitation prior to surgery. In patients with NAFLD dietary and pharmacological interventions can reduce IHF within this timeframe but this approach to modifying IHF is untested in this population. In this review, the aetiology of CAS and CASH is reviewed with recommendations to identify those at risk. We also focus on the post-chemotherapy washout period, reviewing dietary interventions applied to the metabolic population and suggest this window may be used as an opportunity to optimise IHF with such a regime as part of a pre-operative prehabilitation programme to produce improved patient outcomes.
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13
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Yu JJ, Shen F, Chen TH, Liang L, Han J, Xing H, Zhou YH, Wang H, Gu WM, Lau WY, Yang T. Multicentre study of the prognostic impact of preoperative bodyweight on long-term prognosis of hepatocellular carcinoma. Br J Surg 2019; 106:276-285. [PMID: 30199100 DOI: 10.1002/bjs.10981] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/09/2018] [Accepted: 07/20/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Whether preoperative bodyweight is associated with long-term prognosis in patients after liver resection for hepatocellular carcinoma (HCC) is controversial. This study aimed to investigate the relationship of patient weight with long-term recurrence and overall survival (OS) after curative liver resection for HCC. METHODS Data for patients with HCC who underwent curative liver resection between 2000 and 2015 in five centres in China were analysed retrospectively in three groups according to their preoperative BMI: underweight (BMI 18·4 kg/m2 or less), normal weight (BMI 18·5-24·9 kg/m2 ) and overweight (BMI 25·0 kg/m2 or above). Patients' baseline characteristics, operative variables and long-term survival outcomes were compared. Univariable and multivariable Cox regression analyses were performed to identify risk factors for OS and recurrence-free survival (RFS) after resection. RESULTS Of 1524 patients, 107 (7·0 per cent) were underweight, 891 (58·5 per cent) were of normal weight and 526 (34·5 per cent) were overweight. Univariable analyses showed that underweight and overweight patients had poorer OS (both P < 0·001) and RFS (both P < 0·001) than patients of normal weight. Multivariable Cox regression analysis also identified both underweight and overweight to be independent risk factors for OS (hazard ratio (HR) 1·22, 95 per cent c.i. 1·19 to 1·56, P = 0·019; and HR 1·57, 1·36 to 1·81, P < 0·001, respectively) and RFS (HR 1·28, 1·16 to 1·53, P = 0·028; and HR 1·34, 1·17 to 1·54, P < 0·001). CONCLUSION Underweight and overweight patients appear to have a worse prognosis than those of normal weight following liver resection for HCC.
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Affiliation(s)
- J J Yu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
- Department of Clinical Medicine, Second Military Medical University, Shanghai, China
| | - F Shen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - T H Chen
- Department of General Surgery, Ziyang First People's Hospital, Sichuan, China
| | - L Liang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - J Han
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - H Xing
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Y H Zhou
- Department of Hepatobiliary Surgery, Pu'er People's Hospital, Yunnan, China
| | - H Wang
- Department of General Surgery, Liuyang People's Hospital, Hunan, China
| | - W M Gu
- The First Department of General Surgery, Fourth Hospital of Harbin, Heilongjiang, China
| | - W Y Lau
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China
| | - T Yang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
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14
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Desjardin M, Bonhomme B, Le Bail B, Evrard S, Brouste V, Desolneux G, Fonck M, Bécouarn Y, Béchade D. Hepatotoxicities Induced by Neoadjuvant Chemotherapy in Colorectal Cancer Liver Metastases: Distinguishing the True From the False. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2019; 13:1179554918825450. [PMID: 30718969 PMCID: PMC6348554 DOI: 10.1177/1179554918825450] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/25/2018] [Indexed: 02/06/2023]
Abstract
Background: Pre-operative chemotherapy for colorectal liver metastasis (CRLM) is thought to be the cause of hepatotoxicity of non-tumoural parenchyma. Studies on hepatotoxicity are contradictory. We investigated the impact of a single-line pre-operative chemotherapy on non-tumoural liver analysed by an expert hepatico-pancreatico-biliary pathologist, and the consequences on surgical outcomes. Patients and methods: Patients operated for CRLM, after a pure first-line pre-operative chemotherapy, were retrospectively included. Two comparative histopathological analyses were performed for vascular toxicity and steatohepatitis. Results: Between 2003 and 2015, 147 patients were included. Chemotherapy was based on oxaliplatin (40.1%), irinotecan (55.8%), or both (4.1%). The expert pathologist described 38.8% of vascular lesions including dilation, nodular regeneration, and peliosis. In multivariate analysis, vascular lesions correlated to male sex (P = .01), pre-operative platelets <150 g/L (P = .04), and aspartate aminotransferase to platelet ratio index (APRI) score >0.36 (P = .02). Steatohepatitis was observed in 15 patients (10.2%), more frequently after irinotecan (14.8% vs 3.4%, P = .01; odds ratio [OR] = 7.3; 95% confidence interval [CI] = [1.5-34.7]), and for patients with body mass index (BMI) >25 kg/m2 (P = .004; OR = 10.0; 95% CI = [2.1-47.5]). A total of 29 patients (19.7%) developed major complications with 2 risk factors: portal vein obstruction (PVO) and septic surgery. Reproducibility assessment of steatohepatitis and dilated lesions by 2 pathologists showed moderate agreement (Kappa score 0.53 and 0.54, respectively). Conclusions: There is a probable association between non-alcoholic steatohepatitis (NASH) and irinotecan. Oxaliplatin seems to lead to higher vascular lesions. Except in the presence of pre-existent comorbidities, liver toxicities should not restrain the use of pre-operative chemotherapy prior to parenchymal-sparing surgery.
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Affiliation(s)
| | | | - Brigitte Le Bail
- Department of Anatomopathology, University Hospital, Bordeaux, France
| | - Serge Evrard
- Digestive Tumours Unit, Institut Bergonié, Bordeaux, France
| | - Véronique Brouste
- Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France
| | | | - Marianne Fonck
- Digestive Tumours Unit, Institut Bergonié, Bordeaux, France
| | - Yves Bécouarn
- Digestive Tumours Unit, Institut Bergonié, Bordeaux, France
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15
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The influence of steatosis on the short- and long-term results of resection of liver metastases from colorectal carcinoma. HPB (Oxford) 2016; 18:389-96. [PMID: 27037210 PMCID: PMC4814618 DOI: 10.1016/j.hpb.2015.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/16/2015] [Indexed: 12/12/2022]
Abstract
UNLABELLED We aimed to establish whether the presence of hepatic steatosis influences outcome after resection of colorectal liver metastases (CLM). PATIENTS AND METHODS Patients operated between 1990 and 2014 were divided into four groups based on the degree of hepatic steatosis. The association between hepatic steatosis and outcome was analyzed, using a multivariate and a propensity score case-match analysis. RESULTS No significant differences were observed between patients with and without steatosis in either mortality or morbidity in the complete series or after matching (3.2% vs. 3.5%/p = 0.845) (32.3% vs 31.4%/p = 0.802). Five-year survival in patients with and without steatosis were 56.5% and 46.5% respectively (p = 0.046). The steatosis had a significant protective effect in the univariate analysis (HR (95% CI) = 0.78 (0.62-0.99) p = 0.048), and was close to significance in the multivariate analysis (HR (95%) = 0.81 (0.63-1.03) p = 0.089). No significant differences were seen with regard to liver recurrence. CONCLUSIONS The presence of steatosis does not predict short-outcome after resection of CLM, but appears to be a favorable prognostic factor for survival. This protective effect does not depend on a decrease in liver recurrence.
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16
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Patel GS, Ullah S, Beeke C, Hakendorf P, Padbury R, Price TJ, Karapetis CS. Association of BMI with overall survival in patients with mCRC who received chemotherapy versus EGFR and VEGF-targeted therapies. Cancer Med 2015. [PMID: 26211512 PMCID: PMC4618617 DOI: 10.1002/cam4.490] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Although a raised body mass index (BMI) is associated with increased risk of colorectal cancer (CRC) and recurrence after adjuvant treatment, data in the metastatic setting is limited. We compared overall survival (OS) across BMI groups for metastatic CRC, and specifically examined the effect of BMI within the group of patients treated with targeted therapies (TT). Retrospective data were obtained from the South Australian Registry for mCRC from February 2006 to October 2012. The BMI at first treatment was grouped as underweight <18.5 kg/m2, Normal = 18.5 to <25 kg/m2, Overweight = 25 to <30 kg/m2, Obese I = 30 to <35 kg/m2, Obese II ≥35 kg/m2. Of 1174 patients, 42 were underweight, 462 overweight, 175 Obese I, and 77 Obese II. The OS was shorter for patients who were underweight and overweight compared to normal (OS 13.7 and 22.3 vs. 24.1 months, respectively, hazard ratio [HR] 2.21 and 1.23). The adjusted median OS was longer for normal versus overweight or obese I patients receiving chemotherapy + targeted therapy (35.7 vs 25.1 or 22.8 months, HR 1.59 and 1.63, respectively) with no difference in OS for chemotherapy alone. On breakdown by type of targeted therapy, overweight and obese I patients had a poorer outcome with Bevacizumab. The BMI is predictive of a poorer outcome for underweight and overweight patients in the whole population. Of those receiving chemotherapy and targeted therapy, BMI is an independent predictor for OS for overweight and obese I patients, specifically for those treated with Bevacizumab. Patients who are overweight or obese (group I) may be a target group for lifestyle and nutrition advice to improve OS with TT.
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Affiliation(s)
- Gargi S Patel
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Shahid Ullah
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Carol Beeke
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
| | - Paul Hakendorf
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Robert Padbury
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia.,Department of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Timothy J Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Christos S Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia.,Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
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Amptoulach S, Gross G, Kalaitzakis E. Differential impact of obesity and diabetes mellitus on survival after liver resection for colorectal cancer metastases. J Surg Res 2015; 199:378-85. [PMID: 26115811 DOI: 10.1016/j.jss.2015.05.059] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Data on the potential effect of obesity and diabetes mellitus on survival after liver resection due to colorectal cancer (CRC) metastases are very limited. METHODS Patients undergoing liver resection for CRC metastases in a European institution in 2004-2011 were retrospectively enrolled. Relevant data, such as body mass index, extent of resection, chemotherapy, and perioperative outcome, were collected from medical records. The relation of obesity and diabetes mellitus with overall and disease-free survival was assessed using adjusted Cox models. RESULTS Thirty of 207 patients (14.4%) included in the study were obese (BMI ≥30 kg/m(2)) and 25 (12%) had diabetes mellitus. Major hepatectomy was performed in 46%. Although both obese patients and those with diabetes had higher American Society of Anesthesiologist scores (P < 0.05 for both), neither obesity nor diabetes was significantly related to primary tumor characteristics, liver metastasis features, extent or radicality of resection, extrahepatic disease at hepatectomy, preoperative or postoperative oncologic therapy, or perioperative outcome (P > 0.05 for all). Patients were followed up for a median of 39 mo posthepatectomy (interquartile range, 13-56 mo). After adjustment for confounders, obesity was an independent predictor of improved (hazard ratio, 0.305, 95% confidence interval, 0.103-0.902) and diabetes of worse overall survival (hazard ratio, 3.298, 95% confidence interval, 1.306-8.330). Obese patients with diabetes had also worse disease-free survival compared with the rest of the cohort (P < 0.05). CONCLUSIONS After hepatectomy for CRC metastases, obesity does not seem to be associated to poor outcome while diabetes mellitus has a negative impact on prognosis.
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Affiliation(s)
- Sousana Amptoulach
- Department of Oncology, Skåne University Hospital, University of Lund, Malmö, Sweden
| | - Gillis Gross
- Institution of Clinical Sciences, Faculty of Medicine, University of Lund, Lund, Sweden
| | - Evangelos Kalaitzakis
- Institution of Clinical Sciences, Faculty of Medicine, University of Lund, Lund, Sweden.
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Cauchy F, Belghiti J. A clinical perspective of the link between metabolic syndrome and hepatocellular carcinoma. J Hepatocell Carcinoma 2015; 2:19-27. [PMID: 27508191 PMCID: PMC4918280 DOI: 10.2147/jhc.s44521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Metabolic syndrome (MS), which is defined as a constellation of clinico-biological features closely related to insulin-resistance has reached epidemic levels in Western Europe and Northern America. Non-alcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of MS. As its incidence parallels that of MS, NAFLD is currently becoming one of the most frequent chronic liver diseases in Western countries. On one hand, MS favors the development of hepatocellular carcinoma (HCC) either through NAFLD liver parenchymal alterations (steatosis; steatohepatitis; fibrosis), or in the absence of significant underlying liver parenchyma changes. In this setting, HCC are often diagnosed incidentally, tend to be larger than in patients developing HCC on cirrhosis and therefore frequently require major liver resections. On the other hand, MS patients are at increased risk of both liver-related postoperative complications and increased cardiorespiratory events leading to non-negligible mortality rates following liver surgery. These deleterious effects seem to be related to the existence of impaired liver function even in the absence of severe fibrosis but also higher cardiorespiratory sensitivity in a setting of MS/NAFLD. Hence, specific medical and surgical improvements in the perioperative management of these patients are required. These include complete preoperative cardiorespiratory work-up and the wide use of preoperative liver volume modulation. Finally, the long-term prognosis after curative surgery for MS-related HCC does not seem to be worse than for other HCC occurring on classical chronic liver diseases. This is probably related to less aggressive tumor behavior with lower micro vascular invasion and decreased rates of poorly differentiated lesions. In this setting, several medical therapies including metformin could be of value in the prevention of both occurrence and recurrence of HCC.
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Affiliation(s)
- François Cauchy
- HPB and Liver Transplantation Unit, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Jacques Belghiti
- HPB and Liver Transplantation Unit, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
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19
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Equivalent survival in patients with and without steatosis undergoing resection for colorectal liver metastases following pre-operative chemotherapy. Eur J Surg Oncol 2014; 40:1436-44. [DOI: 10.1016/j.ejso.2014.07.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 07/24/2014] [Indexed: 12/15/2022] Open
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Cauchy F, Fuks D, Zarzavadjian Le Bian A, Belghiti J, Costi R. Metabolic syndrome and non-alcoholic fatty liver disease in liver surgery: The new scourges? World J Hepatol 2014; 6:306-14. [PMID: 24868324 PMCID: PMC4033288 DOI: 10.4254/wjh.v6.i5.306] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 01/01/2014] [Accepted: 01/17/2014] [Indexed: 02/06/2023] Open
Abstract
The aim of this topic highlight is to review relevant evidence regarding the influence of the metabolic syndrome (MS) and its associated liver manifestation, non-alcoholic fatty liver disease (NAFLD), on the development of liver cancer as well as their impact on the results of major liver surgery. MS and NAFLD, whose incidences are significantly increasing in Western countries, are leading to a changing profile of the patients undergoing liver surgery. A MEDLINE search was performed for relevant articles using the key words "metabolic syndrome", "liver resection", "liver transplantation", "non alcoholic fatty liver disease", "non-alcoholic steatohepatitis" and "liver cancer". On one hand, the MS favors the development of primary liver malignancies (hepatocellular carcinoma and cholangiocarcinoma) either through NAFLD liver parenchymal alterations (steatosis, steatohepatitis, fibrosis) or in the absence of significant underlying liver parenchyma changes. Also, the existence of NAFLD may have a specific impact on colorectal liver metastases recurrence. On the other hand, the postoperative period following partial liver resection and liver transplantation is at increased risk of both postoperative complications and mortality. These deleterious effects seem to be related to the existence of liver specific complications but also higher cardio-vascular sensitivity in a setting of MS/NAFLD. Finally, the long-term prognosis after curative surgery joins that of patients operated on with other types of underlying liver diseases. An increased rate of patients with MS/NAFLD referred to hepatobiliary units has to be expected. The higher operative risk observed in this subset of patients will require specific improvements in their perioperative management.
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Affiliation(s)
- François Cauchy
- François Cauchy, David Fuks, Jacques Belghiti, Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, 92110 Clichy, France
| | - David Fuks
- François Cauchy, David Fuks, Jacques Belghiti, Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, 92110 Clichy, France
| | - Alban Zarzavadjian Le Bian
- François Cauchy, David Fuks, Jacques Belghiti, Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, 92110 Clichy, France
| | - Jacques Belghiti
- François Cauchy, David Fuks, Jacques Belghiti, Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, 92110 Clichy, France
| | - Renato Costi
- François Cauchy, David Fuks, Jacques Belghiti, Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, 92110 Clichy, France
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Parkin E, O'Reilly DA, Sherlock DJ, Manoharan P, Renehan AG. Excess adiposity and survival in patients with colorectal cancer: a systematic review. Obes Rev 2014; 15:434-51. [PMID: 24433336 DOI: 10.1111/obr.12140] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 11/21/2013] [Accepted: 12/04/2013] [Indexed: 12/19/2022]
Abstract
Excess adiposity is an established risk factor for incident colorectal cancer (CRC) but whether this association extrapolates to poorer survival is unclear. We undertook a systematic review to examine relationships between measures of adiposity and survival in patients with CRC. For distinction, we included pre-diagnosis exposure and CRC-related mortality. We performed dose-response meta-analyses and assessed study quality using eight domains of bias. Six study categories were identified based on (i) timing of adiposity measurement relative to survival analysis time zero and (ii) clinical setting. Several types of adiposity measurements were reported; body mass index (BMI) was the commonest. For pre-diagnosis cohorts, baseline BMI negatively impacted on CRC-related mortality in men only (risk estimate per 5 kg m(-2) = 1.19, 95% confidence intervals: 1.14-1.25). The other groups were pre-diagnosis BMI but diagnosis as time zero; population-based cohorts; treatment cohorts; observational analyses within adjuvant chemotherapy trials; patients with metastatic CRC - each had several biases (e.g. treatment selection, reverse causality) and sources of confounding (e.g. chemotherapy 'capping'). Overall, there was insufficient evidence for a strong link between adiposity and survival. These findings demonstrate an important principle: an established link between an exposure (here, adiposity) and increased cancer incidence does not necessarily extrapolate into an inferior post-treatment outcome.
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Affiliation(s)
- Edward Parkin
- Institute of Cancer Sciences, University of Manchester, Manchester, UK; Department of Hepatobiliary Surgery, North Manchester General Hospital, Manchester, UK
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22
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Dunne DF, Jones RP, Malik HZ, Fenwick SW, Poston GJ. Surgical management of colorectal liver metastases: a European perspective. Hepat Oncol 2013; 1:121-133. [PMID: 30190946 DOI: 10.2217/hep.13.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The treatment of colorectal cancer metastatic to the liver is increasingly complex as a result of changes in the patient population, advances in preoperative staging, changing definitions of resectability, advances in surgical technique and the expanding chemotherapeutic armamentarium. Management of these patients within a multidisciplinary team is increasingly important and associated with better outcomes. In patients with irresectable hepatic metastases, high secondary resection rates can be achieved with multiagent chemotherapy when managed in conjunction with a liver specialist. Perioperative mortality rates are reducing but morbidity remains high, and enhanced recovery could help reduce morbidity. Despite the advancing age and comorbidity of the patient population, multimodal management is likely to lead to further improvements in perioperative and long-term outcomes.
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Affiliation(s)
- Declan Fj Dunne
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
| | - Robert P Jones
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
| | - Hassan Z Malik
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
| | - Stephen W Fenwick
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
| | - Graeme J Poston
- Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, University Hospital Aintree, Liverpool, L9 7AL, UK
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Volumetric Gain of the Liver after Major Hepatectomy in Obese Patients. Ann Surg 2013; 258:696-702; discussion 702-4. [DOI: 10.1097/sla.0b013e3182a61a22] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Parkin E, O'Reilly DA, Adam R, Kaiser GM, Laurent C, Elias D, Capussotti L, Renehan AG. The effect of hepatic steatosis on survival following resection of colorectal liver metastases in patients without preoperative chemotherapy. HPB (Oxford) 2013; 15:463-72. [PMID: 23458109 PMCID: PMC3664051 DOI: 10.1111/hpb.12007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 10/17/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic steatosis, a common condition associated with insulin resistance and excess body weight, is reported to be associated with an increased risk for perioperative mortality in patients undergoing resection of colorectal liver metastases (CLM), but its impact upon longterm survival is less well documented. METHODS The effects of background liver pathology, categorized as 'normal', 'with steatosis' and 'other', on perioperative mortality, overall survival (OS) and cancer-specific survival (CSS) were assessed in patients undergoing resection for CLM according to data maintained in the LiverMetSurvey database. As preoperative chemotherapy may confound the effects of steatosis, patients who had been given preoperative chemotherapy were excluded. Survival analyses included log-rank tests for comparisons, and multivariate Cox models, including well-established prognosticators. RESULTS Of 5853 patients who underwent first-time liver resection without preoperative chemotherapy, 1793 (30.6%) had background steatosis. Rates of 90-day perioperative mortality in patients with normal, steatosis and other pathologies were 2.8%, 2.1% and 4.9%, respectively. Steatosis was associated with improved 5-year OS (47.4% versus 43.0%; log rank, P = 0.0017) and CSS (56.1% versus 50.3%; P = 0.002) compared with normal background liver. After adjustments, the survival advantage associated with steatosis remained (hazard ratio = 0.806, 95% confidence interval 0.717-0.905 for CSS). DISCUSSION The paradoxical survival advantage observed in patients with steatosis undergoing liver resection for CLM generates a hypothesis that peri-diagnosis of excess body adiposity has a survival protective effect that warrants further research.
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Affiliation(s)
- Ed Parkin
- Institute of Cancer Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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Bower M, Wunderlich C, Brown R, Scoggins CR, McMasters KM, Martin RC. Obesity rather than neoadjuvant chemotherapy predicts steatohepatitis in patients with colorectal metastasis. Am J Surg 2013; 205:685-90. [DOI: 10.1016/j.amjsurg.2012.07.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 06/19/2012] [Accepted: 07/17/2012] [Indexed: 01/13/2023]
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Yamazaki S, Takayama T, Okada S, Iwama A, Midorikawa Y, Moriguchi M, Nakayama H, Higaki T, Sugutani M. Good Candidates for a Third Liver Resection of Colorectal Metastasis. World J Surg 2013; 37:847-853. [DOI: 10.1007/s00268-012-1887-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AbstractBackgroundHaving three liver resections for colorectal metastases has long been considered to be associated with a high risk of postoperative complications. The present study was designed to assess the feasibility and survival benefits of three liver resections.MethodsBetween 2004 and 2011, data for 273 consecutive patients with colorectal metastases were analyzed. The patient characteristics, tumor status, operation‐related variables, degree of liver steatosis, and short‐ and long‐term outcomes were compared according to the number of liver resections.ResultsThe history of preoperative chemotherapy was higher for patients who had had three liver resections as compared with other resections: i.e., one resection 41.0 %, versus two resections 56.8 %, versus three resections 81.8 %; p = 0.04. Patients receiving three liver resections had a high rate of liver steatosis (17.9 vs. 32.4 vs. 59.1 %; p = 0.03). The median operative time for three resections was significantly longer than for the other resections (359 min [range: 115–579 min] vs. 395 min [range: 178–740 min], vs. 482 min [range: 195–616 min]; p = 0.04). However, the complication rate and the postoperative hospital stay did not differ among the three groups. The 1‐, 3‐ and 5‐year survival rates did not differ significantly among the three groups (83.3, 57.5, and 44.6 % for one resection vs. 92.3, 52.1, and 35.7 % for two resections vs. 93.3, 49.0, and 34.1 % for three resections). Patients who had <5 tumors at a third liver resection and a recurrence interval of ≥500 days from the second resection were good candidates for three resections.ConclusionsUndergoing three resections of colorectal metastasis is feasible and provides a similar survival benefit as one or two resections, without increasing morbidity or mortality.
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Affiliation(s)
- Shintaro Yamazaki
- Department of Digestive Surgery Nihon University School of Medicine 30‐1 Ohyaguchikami‐machi, Itabashi‐ku 173‐8610 Tokyo Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery Nihon University School of Medicine 30‐1 Ohyaguchikami‐machi, Itabashi‐ku 173‐8610 Tokyo Japan
| | - Shunji Okada
- Department of Digestive Surgery Nihon University School of Medicine 30‐1 Ohyaguchikami‐machi, Itabashi‐ku 173‐8610 Tokyo Japan
| | - Atsuko Iwama
- Department of Digestive Surgery Nihon University School of Medicine 30‐1 Ohyaguchikami‐machi, Itabashi‐ku 173‐8610 Tokyo Japan
| | - Yutaka Midorikawa
- Department of Digestive Surgery Nihon University School of Medicine 30‐1 Ohyaguchikami‐machi, Itabashi‐ku 173‐8610 Tokyo Japan
| | - Masamichi Moriguchi
- Department of Digestive Surgery Nihon University School of Medicine 30‐1 Ohyaguchikami‐machi, Itabashi‐ku 173‐8610 Tokyo Japan
| | - Hisashi Nakayama
- Department of Digestive Surgery Nihon University School of Medicine 30‐1 Ohyaguchikami‐machi, Itabashi‐ku 173‐8610 Tokyo Japan
| | - Tokio Higaki
- Department of Digestive Surgery Nihon University School of Medicine 30‐1 Ohyaguchikami‐machi, Itabashi‐ku 173‐8610 Tokyo Japan
| | - Masahiko Sugutani
- Department of Pathology Nihon University School of Medicine 30‐1 Ohyaguchikami‐machi, Itabashi‐ku 173‐8610 Tokyo Japan
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Zarzavadjian Le Bian A, Costi R, Constantinides V, Smadja C. Metabolic disorders, non-alcoholic fatty liver disease and major liver resection: an underestimated perioperative risk. J Gastrointest Surg 2012; 16:2247-55. [PMID: 23054903 DOI: 10.1007/s11605-012-2044-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 09/26/2012] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Despite increasing evidence of an association of metabolic syndrome and liver degeneration, little is known about the results of major hepatic resection in patients with metabolic disorders. Following the observation of some unexplained perioperative deaths following uncomplicated right hepatectomy in patients presenting metabolic disorders, we analyzed the perioperative mortality in such population. MATERIAL AND METHODS A retrospective analysis of immediate outcome was performed of patients undergoing right hepatectomy and affected by two or more metabolic disorders (diabetes mellitus, hypertension, dyslipidemia, obesity/overweight) without any other known cause of liver disease from January 2001 to May 2010. RESULTS Among 151 patients undergoing right hepatectomy, 30 patients presented two or more metabolic disorders. Perioperative mortality in this group reached 30 % (nine patients). In patients presenting MS (≥3 disorders), mortality reached 54 %. Univariate analysis identified four criteria associated with poor prognosis: MS, perioperative bleeding ≥1,000 mL, middle hepatic vein resection and primary hepatic malignancy. At multivariate analysis, middle hepatic vein resection and underlying primary hepatic malignancy resulted as being related to mortality. CONCLUSIONS Patients presenting with multiple metabolic disorders should be carefully evaluated before major liver resection, especially when the procedure is planned for hepatocellular carcinoma and when a middle hepatic vein resection is required.
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Affiliation(s)
- Alban Zarzavadjian Le Bian
- Service de Chirurgie Digestive, Hôpital Antoine Béclère, Clamart, Assistance Publique, Hôpitaux de Paris, Université Paris XI, France.
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Glasgow Prognostic Score as a useful prognostic factor after hepatectomy for hepatocellular carcinoma. Int J Clin Oncol 2012; 18:829-38. [DOI: 10.1007/s10147-012-0451-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 07/01/2012] [Indexed: 12/22/2022]
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30
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van Vledder MG, Levolger S, Ayez N, Verhoef C, Tran TCK, Ijzermans JNM. Body composition and outcome in patients undergoing resection of colorectal liver metastases. Br J Surg 2012; 99:550-7. [PMID: 22246799 DOI: 10.1002/bjs.7823] [Citation(s) in RCA: 367] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Recent evidence suggests that depletion of skeletal muscle mass (sarcopenia) and an increased amount of intra-abdominal fat (central obesity) influence cancer statistics. This study investigated the impact of sarcopenia and central obesity on survival in patients undergoing liver resection for colorectal liver metastases (CLM). METHODS Diagnostic imaging from patients who had hepatic resection for CLM in one centre between 2001 and 2009, and who had assessable perioperative computed tomograms, was analysed retrospectively. Total cross-sectional areas of skeletal muscle and intra-abdominal fat, and their influence on outcome, were analysed. RESULTS Of the 196 patients included in the study, 38 (19·4 per cent) were classified as having sarcopenia. Five-year disease-free (15 per cent versus 28·5 per cent in patients without sarcopenia; P = 0·002) and overall (20 per cent versus 49·9 per cent respectively; P < 0·001) survival rates were lower for patients with sarcopenia at a median follow-up of 29 (range 1-97) months. Sarcopenia was an independent predictor of worse recurrence-free (hazard ratio (HR) 1·88, 95 per cent confidence interval 1·25 to 2·82; P = 0·002) and overall (HR 2·53, 1·60 to 4·01; P < 0·001) survival. Central obesity was associated with an increased risk of recurrence in men (P = 0·032), but not in women (P = 0·712). CONCLUSION Sarcopenia has a negative impact on cancer outcomes following resection of CLM.
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Affiliation(s)
- M G van Vledder
- Department of Surgery, Erasmus MC, Rotterdam, 'S Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Peng J, Wei YS, Peng HP. Colorectal chemotherapy-associated liver injury. Shijie Huaren Xiaohua Zazhi 2011; 19:3359-3364. [DOI: 10.11569/wcjd.v19.i32.3359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The increasing use of more effective chemotherapy in patients with colorectal cancer has raised awareness of the potential liver injuries induced by systemic drugs, such as fluorouracil, oxaliplatin and irinotecan. Chemotherapy-associated liver injuries can be revealed by histopathologic examination of nontumoral liver tissue. There are two broad categories of chemotherapy-induced liver injury: non-alcoholic fatty liver disease and sinusoidal injury. Many reports suggest that liver injuries may increase morbidity and mortality in patients who undergo hepatic resection for colorectal liver metastases, while some researchers have opposing views. This review describes the main types of chemotherapy-related liver injury and current controversy over this topic.
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32
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Current world literature. Curr Opin Lipidol 2011; 22:231-6. [PMID: 21562387 DOI: 10.1097/mol.0b013e328347aeca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vrieling A, Kampman E. The role of body mass index, physical activity, and diet in colorectal cancer recurrence and survival: a review of the literature. Am J Clin Nutr 2010. [DOI: 10.3945/ajcn.2009.29005] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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