Estimation of the future remnant liver function is a better tool to predict post-hepatectomy liver failure than platelet-based liver scores.

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.

• Authors: T Chapelle, B Op de Beeck, A Driessen, G Roeyen, B Bracke, V Hartman, I Huyghe, S Morrison, D Ysebaert, S Francque
• Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 43 Issue 12 Pg. 2277-2284 (Dec 2017) ISSN: 1532-2157 [Electronic] England
• PMID: 28988766 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Chemical References

• Aniline Compounds
• Imino Acids
• Organoplatinum Compounds
• Organotechnetium Compounds
• Radiopharmaceuticals
• Oxaliplatin
• Irinotecan
• technetium Tc 99m mebrofenin
• Glycine
• Camptothecin

Topics

• Aniline Compounds
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Camptothecin (administration & dosage, analogs & derivatives)
• Colorectal Neoplasms (pathology)
• Female
• Glycine
• Hepatectomy
• Humans
• Imino Acids
• Irinotecan
• Liver Failure (diagnostic imaging, etiology, mortality)
• Liver Function Tests
• Liver Neoplasms (drug therapy, secondary, surgery)
• Male
• Middle Aged
• Organoplatinum Compounds (administration & dosage)
• Organotechnetium Compounds
• Oxaliplatin
• Platelet Function Tests
• Predictive Value of Tests
• Radiopharmaceuticals
• Treatment Outcome