The Impact of Modern Chemotherapy and Chemotherapy-Associated Liver Injuries (CALI) on Liver Function: Value of 99mTc-Labelled-Mebrofenin SPECT-Hepatobiliary Scintigraphy.


Journal

Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840

Informations de publication

Date de publication:
Apr 2021
Historique:
received: 18 11 2019
accepted: 16 04 2020
pubmed: 25 8 2020
medline: 15 5 2021
entrez: 25 8 2020
Statut: ppublish

Résumé

Chemotherapy is increasingly used before hepatic resection, with controversial impact regarding liver function. This study aimed to assess the capacity of 99mTc-labelled-mebrofenin SPECT-hepatobiliary scintigraphy (HBS) to predict liver dysfunction due to chemotherapy and/or chemotherapeutic-associated liver injuries (CALI), such as sinusoidal obstruction syndrome (SOS) and nonalcoholic steatohepatitis (NASH) activity score (NAS). From 2011 to 2015, all consecutive noncirrhotic patients scheduled for a major hepatectomy (≥ 3 segments) gave informed consent for preoperative SPECT-HBS allowing measurements of segmental liver function. As primary endpoint, HBS results were compared between patients with versus without (1) preoperative chemotherapy (≤ 3 months); and (2) CALI, mainly steatosis, NAS (Kleiner), or SOS (Rubbia-Brandt). Secondary endpoints were (1) other factors impairing function; and (2) impact of chemotherapy, and/or CALI on hepatocyte isolation outcome via liver tissues. Among 115 patients, 55 (47.8%) received chemotherapy. Sixteen developed SOS and 35 NAS, with worse postoperative outcome. Overall, chemotherapy had no impact on liver function, except above 12 cycles. In patients with CALI, a steatosis ≥ 30% significantly compromised function, as well as NAS, especially grades 2-5. Conversely, SOS had no impact, although subjected to very low patients number with severe SOS. Other factors impairing function were diabetes, overweight/obesity, or fibrosis. Similarly, chemotherapy in 73 of 164 patients had no effect on hepatocytes isolation outcome; regarding CALI, steatosis ≥ 30% and NAS impaired the yield and/or viability of hepatocytes, but not SOS. In this first large, prospective study, HBS appeared to be a valuable tool to select heavily treated patients at risk of liver dysfunction through steatosis or NAS.

Sections du résumé

BACKGROUND BACKGROUND
Chemotherapy is increasingly used before hepatic resection, with controversial impact regarding liver function. This study aimed to assess the capacity of 99mTc-labelled-mebrofenin SPECT-hepatobiliary scintigraphy (HBS) to predict liver dysfunction due to chemotherapy and/or chemotherapeutic-associated liver injuries (CALI), such as sinusoidal obstruction syndrome (SOS) and nonalcoholic steatohepatitis (NASH) activity score (NAS).
METHODS METHODS
From 2011 to 2015, all consecutive noncirrhotic patients scheduled for a major hepatectomy (≥ 3 segments) gave informed consent for preoperative SPECT-HBS allowing measurements of segmental liver function. As primary endpoint, HBS results were compared between patients with versus without (1) preoperative chemotherapy (≤ 3 months); and (2) CALI, mainly steatosis, NAS (Kleiner), or SOS (Rubbia-Brandt). Secondary endpoints were (1) other factors impairing function; and (2) impact of chemotherapy, and/or CALI on hepatocyte isolation outcome via liver tissues.
RESULTS RESULTS
Among 115 patients, 55 (47.8%) received chemotherapy. Sixteen developed SOS and 35 NAS, with worse postoperative outcome. Overall, chemotherapy had no impact on liver function, except above 12 cycles. In patients with CALI, a steatosis ≥ 30% significantly compromised function, as well as NAS, especially grades 2-5. Conversely, SOS had no impact, although subjected to very low patients number with severe SOS. Other factors impairing function were diabetes, overweight/obesity, or fibrosis. Similarly, chemotherapy in 73 of 164 patients had no effect on hepatocytes isolation outcome; regarding CALI, steatosis ≥ 30% and NAS impaired the yield and/or viability of hepatocytes, but not SOS.
CONCLUSIONS CONCLUSIONS
In this first large, prospective study, HBS appeared to be a valuable tool to select heavily treated patients at risk of liver dysfunction through steatosis or NAS.

Identifiants

pubmed: 32833150
doi: 10.1245/s10434-020-08988-4
pii: 10.1245/s10434-020-08988-4
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1959-1969

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Auteurs

Stéphanie Truant (S)

Department of Digestive Surgery and Transplantation, Univ. Lille, CHRU Lille, Lille, France. stephanie.truant@chru-lille.fr.
CANTHER laboratory Cancer Heterogeneity, Plasticity and Resistance to Therapies UMR-S1277 INSERM, Team Mucins, Cancer and Drug Resistance, 59000, Lille, France. stephanie.truant@chru-lille.fr.

Clio Baillet (C)

Department of Nuclear Medicine, Univ. Lille, Lille, France.

Viviane Gnemmi (V)

Department of Pathology, Univ. Lille, Lille, France.

Maxence Fulbert (M)

Department of Digestive Surgery and Transplantation, Univ. Lille, CHRU Lille, Lille, France.

Anthony Turpin (A)

Department of Medical Oncology, Univ. Lille, Lille, France.

Sabrina Dardenne (S)

Department of Digestive Surgery and Transplantation, Univ. Lille, CHRU Lille, Lille, France.

Emmanuelle Leteurtre (E)

Department of Pathology, Univ. Lille, Lille, France.

Mehdi El Amrani (M)

Department of Digestive Surgery and Transplantation, Univ. Lille, CHRU Lille, Lille, France.
CANTHER laboratory Cancer Heterogeneity, Plasticity and Resistance to Therapies UMR-S1277 INSERM, Team Mucins, Cancer and Drug Resistance, 59000, Lille, France.

Sébastien Dharancy (S)

Hepatology Unit, Univ. Lille, Lille, France.
LIRIC-Lille Inflammation Research International Center-U995, Univ. Lille, Inserm, CHU Lille, Lille, France.

Laurent Dubuquoy (L)

Hepatology Unit, Univ. Lille, Lille, France.
LIRIC-Lille Inflammation Research International Center-U995, Univ. Lille, Inserm, CHU Lille, Lille, France.

Damien Huglo (D)

Department of Nuclear Medicine, Univ. Lille, Lille, France.

Christophe Chesné (C)

Biopredic Laboratory, Rennes, France.

François-René Pruvot (FR)

Department of Digestive Surgery and Transplantation, Univ. Lille, CHRU Lille, Lille, France.

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