title: Liver failure in patients treated with chemotherapy for colorectal liver metastases: Role of chronic disease scores in patients undergoing major liver surgery. A case-matched analysis.
abstract: OBJECTIVE
  An accurate and noninvasive tool to predict Chemotherapy Associated Liver Injury (CALI) still lacks. Study aimed to evaluate chronic liver disease scores (Aspartate aminotransferase to Platelet Ratio Index, APRI and Fibrosis-4, FIB-4) as Postoperative Liver Failure (PLF) predictors in patients treated with Oxaliplatin for Colorectal Liver Metastases (CLM).
  
  
  METHODS
  8 patients who developed PLF after major hepatectomy (Group B) were compared to 24 patients who did not develop PLF (Group A) in a case-matched analysis for patients and disease characteristics. ROC curves analysis was performed to assess score accuracy.
  
  
  RESULTS
  In Group A number of CT cycles was lower, (6 vs 9, p NS), interval between treatment and surgery was longer (11 vs 7 weeks, p < 0.05) and bevacizumab was more frequently administered (66.7% vs 37.5%, p < 0.05). In Group B median APRI score was 0.53 (range: 0.86-4.26) whereas in Group A was 0.30 (range: 0.06-2.21, p < 0.05). Median FIB-4 score was 2.46 (range: 0.86-13.65) in Group B and 1.58 (range: 0.27-7.68) in Group A (p < 0.001). Multivariate analysis showed a significant correlation between APRI and the onset of PLF. A good accuracy of APRI score was evident in ROC curves with an area under the curve of 0.72 (p 0.003).
  
  
  CONCLUSIONS
  APRI score is calculated considering both liver damage and platelet count, it is cost effective and easily available. This study demonstrates that there is a good accuracy in PLF prediction and consequently in CT induced liver damage evaluation.
authors.affiliation: Department of General Surgery, Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy. Electronic address: ratti.francesca@hsr.it.
authors.forename: F
authors.initials: F
authors.lastname: Ratti
authors.affiliation: Department of General Surgery, Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Cipriani
authors.affiliation: Department of General Surgery, Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Catena
authors.affiliation: Department of General Surgery, Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Paganelli
authors.affiliation: Department of General Surgery, Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Aldrighetti
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001219:Aspartate Aminotransferases / Q000097:blood; D000068258:Bevacizumab; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000209:etiology*; D002908:Chronic Disease; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D017093:Liver Failure / Q000209:etiology*; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009944:Organoplatinum Compounds / Q000009:adverse effects; D000077150:Oxaliplatin; D010976:Platelet Count; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000068258:Bevacizumab; D001219:Aspartate Aminotransferases
keywords: Chemotherapy; Liver surgery; Metastases; Sinusoidal obstruction; postoperative liver failure