PWE-150 Chemotherapy associated liver injury: a systematic review and meta-analysis
Notice bibliographique
Résumé
Introduction Chemotherapy associated liver injury (CALI) has been associated with increased morbidity and mortality in patients undergoing major hepatectomy to treat colorectal liver metastases (CRLM). In addition a link has recently been made between CALI and poorer long term disease specific outcome. The aim of this review was to determine the pathological effect of specific chemotherapy regimens on the hepatic parenchyma as well as surgical morbidity, mortality and overall survival. Methods A literature search of MEDLINE, EMBASE and the Cochrane Library identified 14 619 potentially relevant reports. Of these 37 full text reports which included patients only with CRLM and provided either histological data or patient outcome data were considered suitable for inclusion in this review. For each report data relating to study design characteristics, histological scoring of the liver parenchyma and peri-operative outcomes were extracted using a standardised proforma. Study quality was assessed using the Newcastle-Ottawa score for non-randomised studies and the grade of evidence assessed according to the Oxford centre for Evidence Based Medicine scale. A meta-analysis was performed utilising the random effects model of DerSimmonian and Laird. Results are reported as RR (±95% CI). Statistical significance was set at p<0.05. Results No association could be demonstrated between the use of pre-operative chemotherapy and the development of hepatic steatosis >30%. The presence of steatohepatitis was associated with the use of pre-operative Irinotecan based chemotherapy (RR 3.45; 95% CI 1.12 to 10.62; p=0.03). Calculating the number needed to harm suggests that one in every 12 patients treated with Irinotecan based chemotherapy could be expected to develop steatohepatitis. Oxaliplatin based chemotherapy regimens are associated with grade 2 or greater sinusoidal injury (RR 4.36; 95% CI 1.12 to 10.62; p=0.03) with a number needed to harm of 8. The use of Bevacizumab alongside Oxaliplatin reduces the risk of grade 2 or greater sinusoidal injury. Conclusion The use of pre-operative chemotherapy is associated with an increased risk of injury to the liver parenchyma in patients with CRLM. This injury occurs in a regimen specific manner with Irinotecan being associated with steatohepatitis whereas Oxaliplatin is associated with sinusoidal injury. This injury may have implications on the functional reserve of the liver following major hepatic resection. Competing interests None declared.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,013 | 0,005 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».