title: Correlations between histopathological diagnosis of chemotherapy-induced hepatic injury, clinical features, and perioperative morbidity.
abstract: BACKGROUND
  Chemotherapy has in some series been linked with increased morbidity after a hepatectomy. Hepatic injuries may result from the treatment with chemotherapy, but can also be secondary to co-morbid diseases. The aim of the present study was to draw correlations between clinical features, treatment with chemotherapy and injury phenotypes and assess the impact of each upon perioperative morbidity.
  
  
  METHODS
  Retrospective samples (n= 232) were scored grading steatosis, steatohepatitis and sinusoidal injury (SI). Clinical data were retrieved from medical records. Correlations were drawn between injury, clinical features and perioperative morbidity.
  
  
  RESULTS
  Injury rates were 18%, 4% and 19% for steatosis, steatohepatitis and SI, respectively. High-grade steatosis was more common in patients with diabetes [odds ratio (OR) = 3.33, P= 0.01] and patients with a higher weight (OR/kg = 1.04, P= 0.02). Steatohepatitis was increased with metabolic syndrome (OR = 5.88, P= 0.02). Chemotherapy overall demonstrated a trend towards an approximately doubled risk of high-grade steatosis and steatohepatitis although not affecting SI. However, pre-operative chemotherapy was associated with an increased SI (OR = 2.18, P= 0.05). Operative morbidity was not increased with chemotherapy, but was increased with steatosis (OR = 2.38, P= 0.02).
  
  
  CONCLUSIONS
  Diabetes and higher weight significantly increased the risk of steatosis, whereas metabolic syndrome significantly increased risk of steatohepatitis. The presence of high-grade steatosis increases perioperative morbidity, not administration of chemotherapy per se.
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Department of Surgery, University of Melbourne, St. Vincent's Hospital, Melbourne, Australia. charlespilgrim@hotmail.com
authors.forename: Charles H C
authors.initials: CH
authors.lastname: Pilgrim
authors.forename: Laveniya
authors.initials: L
authors.lastname: Satgunaseelan
authors.forename: Alan
authors.initials: A
authors.lastname: Pham
authors.forename: William
authors.initials: W
authors.lastname: Murray
authors.forename: Emma
authors.initials: E
authors.lastname: Link
authors.forename: Marty
authors.initials: M
authors.lastname: Smith
authors.forename: Val
authors.initials: V
authors.lastname: Usatoff
authors.forename: Peter M
authors.initials: PM
authors.lastname: Evans
authors.forename: Simon
authors.initials: S
authors.lastname: Banting
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Thomson
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Phillips
authors.forename: Michael
authors.initials: M
authors.lastname: Michael
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D048909:Diabetes Complications / Q000209:etiology; D018572:Disease-Free Survival; D005234:Fatty Liver / Q000139:chemically induced* / Q000401:mortality / Q000473:pathology; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D009765:Obesity / Q000150:complications; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents