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Vauthey descrive il rapporto fra chemoterapia e steatoepatite

Jean-Nicolas Vauthey, all’M.D. Anderson Cancer Center, di Houston, Texas (USA) descrive per la prima volta il rapporto tra chemioterapia sistemica ed insorgenza di steatoepatite.

La steatoepatite è associata a un aumento della mortalità a 90 giorni dopo una chirurgia epatica.

Nei pazienti con metastasi epatiche da tumori colorettali, la scelta di fare una chemioterapia deve essere considerata con molta attenzione, poiché il rischio di epatotossicità è significativo.

La referenza bibliografica per questo evento è:

Jean-Nicolas Vauthey, Timothy M. Pawlik, Dario Ribero, Tsung-Teh Wu, Daria Zorzi, Paulo M. Hoff, Henry Q. Xiong, Cathy Eng, Gregory Y. Lauwers, Mari Mino-Kenudson, Mauro Risio, Andrea Muratore, Lorenzo Capussotti, Steven A. Curley, Eddie K. Abdalla: Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. In: Journal of Clinical Oncology, vol. 24, no 13, pp. 2065 – 2072, 2006, ISSN: 0732183X, (Cited by: 1073).

Abstract

Purpose: Chemotherapy before resection of hepatic colorectal metastases (CRM) may cause hepatic injury and affect postoperative outcome. Patients and Methods: Four hundred six patients underwent hepatic resection of CRM between 1992 and 2005. Pathologic review of the nontumorous liver was performed using established criteria for steatosis, steatohepatitis, and sinusoidal injury. The effect of chemotherapy and liver injury on perioperative outcome was analyzed. Results: One hundred fifty-eight patients (38.9%) received no preoperative chemotherapy, whereas 248 patients (61.1 %) did. The median duration of chemotherapy was 16 weeks (range, 2 to 70 weeks). Chemotherapy consisted of fluoropyrimidine-based regimens (fluorouracil [FU] alone, 15.5%; irinotecan plus FU, 23.1 %; and oxaliplatin plus FU, 19.5%) and other therapy (3.0%). On pathologic analysis, 36 patients (8.9%) had steatosis, 34 (8.4%) had steatohepatitis, and 22 (5.4%) had sinusoidal dilation. Oxaliplatin was associated with sinusoidal dilation compared with no chemotherapy (18.9% v 1.9%, respectively; P < .001; odds ratio [OR] = 8.3; 95% CI, 2.9 to 23.6). In contrast, irinotecan was associated with steatohepatitis compared with no chemotherapy (20.2% v4.4%, respectively; P < .001; OR = 5.4; 95% CI, 2.2 to 13.5). Patients with steatohepatitis had an increased 90-day mortality compared with patients who did not have steatohepatitis (14.7% v 1.6%, respectively; P = .001; OR = 10.5; 95% CI, 2.0 to 36.4). Conclusion: Steatohepatitis is associated with an increased 90-day mortality after hepatic surgery. In patients with hepatic CRM, the chemotherapy regimen should be carefully considered because the risk of hepatotoxicity is significant. © 2006 by American Society of Clinical Oncology.

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