Relationship between survival outcomes in patients with colorectal liver metastasis undergoing hepatectomy and significance of fibrotic markers for liver injury assessment.

BACKGROUND

Progression of chronic liver dysfunction influenced by long-term chemotherapy or repeated hepatectomy might be related to patient overall survival as well as tumor factors in colorectal liver metastasis (CLM) patients. Our aim of this study was to clarify the relationship between fibrotic liver damage and malignant behaviors of CLM malignancy or its long-term survivals by the retrospective cohort study.

METHODS

We examined the relationship between tumor-related factors or six liver fibrosis-associated parameters, including platelet count, hyaluronic acid (HA), mac-2 binding protein glycosylation isomer (M2BPGi), type IV collagen 7S (T4C7), aspartate aminotransferase-to-platelet ratio index (APRI), The fibrosis-4 (Fib-4) index, and clinicopathological parameters, surgical records, and postoperative patient survival in the 45 consecutive patients with CLM who underwent radical hepatectomy.

RESULTS

Fibrotic parameters were platelet count of 23.0±8.5 ×104/µL, HA level of 68.9±82.3 ng/mL, M2BPGi of 0.87±0.48 ng/mL, and type IV collagen level of 5.74±3.76 ng/mL. Platelet count was significantly correlated with HA level (P<0.05) and tended to be correlated with M2BPGi levels (P=0.056). HA level was significantly associated with albumin level (P<0.05). Overall survival in this series showed five-year overall survivors after hepatectomy in 44 patients (98%), but cancer-related deaths were observed in only one patient. Patients with higher grades and increased bilirubin levels demonstrated significantly lower cancer-free survival (P<0.05), but fibrotic parameters were not associated with prognostic factors.

CONCLUSIONS

Fibrotic markers indicating chemotherapy or repeated surgical liver injury were not significant predictive factors reflecting cancer malignant behaviors or patient overall survival, contrary to our hypothesis. The current overall survival status using various modalities for cancer recurrence is satisfactory under our present perioperative management.