LiMAx Test Improves Diagnosis of Chemotherapy-Associated Liver Injury Before Resection of Colorectal Liver Metastases

• Published in: Annals of surgical oncology Vol. 24; no. 9; pp. 2447 - 2455
• Main Authors: Lock, Johan F., Westphal, Tilman, Rubin, Tom, Malinowski, Maciej, Schulz, Antje, Jara, Maximilian, Bednarsch, Jan, Stockmann, Martin
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-09-2017; Springer Nature B.V
• Subjects: Acetamides - metabolism; Aged; Algorithms; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Chemical and Drug Induced Liver Injury - diagnosis; Chemical and Drug Induced Liver Injury - pathology; Chemical and Drug Induced Liver Injury - physiopathology; Chemotherapy; Chemotherapy, Adjuvant - adverse effects; Colorectal Neoplasms - pathology; Diagnosis; Fatty liver; Fatty Liver - pathology; Fatty Liver - physiopathology; Female; Fibrosis; Hepatobiliary Tumors; Humans; Liver; Liver Cirrhosis - pathology; Liver Cirrhosis - physiopathology; Liver Function Tests; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Metastases; Metastasis; Middle Aged; Morbidity; Multivariate analysis; Neoadjuvant Therapy - adverse effects; Obesity - physiopathology; Oncology; Organoplatinum Compounds - administration & dosage; Organoplatinum Compounds - adverse effects; Oxaliplatin; Preoperative Period; Retrospective Studies; Steatosis; Surgery; Surgical Oncology; Survival Rate; Time Factors; Liver Fibrosis; Colorectal Liver Metastasis; Liver Resection; Portal Vein Embolization; Liver Steatosis
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-017-5887-2

Background
Chemotherapy of colorectal liver metastases (CLMs) prior to liver resection implies the risk of chemotherapy-associated liver injury, leading to increased postoperative morbidity and mortality
Objective
The aim of this study was to evaluate the LiMAx (liver maximum capacity) test for diagnosis of chemotherapy-associated liver injury.
Methods
This was a retrospective analysis of patients with CLMs, prior to liver resection. We performed preoperative assessment of liver function using biochemical parameters and the LiMAx test. The individual history of chemotherapy within 12 months, including regimen, number of cycles, and therapy-free interval were collected, and histopathological evaluation of tumor-free liver tissue was performed in resected patients.
Results
A total of 204 patients were included, of whom 127 (62%) had received previous chemotherapy. The LiMAx test was worse after chemotherapy (340 ± 95 vs. 391 ± 82 µg/kg/h;
p

<
 0.001). Impaired LiMAx results (<315 µg/kg/h) were determined in 49% of patients after chemotherapy, and no effects of chemotherapy, liver steatosis or fibrosis on biochemical parameters were observed. LiMAx impairment was dependent on the number of oxaliplatin cycles, the therapy-free interval, and obesity in multivariate analysis. In addition, the LiMAx test was worse in patients with relevant steatosis, fibrosis and steatohepatitis. Patients with an impaired LiMAx showed sufficient regeneration during chemotherapy cessation when surgery was postponed (272 ± 57 – 348 ± 72 µg/kg/h;
p

=
 0.003).
Conclusion
The LiMAx test enables non-invasive preoperative diagnosis of chemotherapy-associated liver injury. Preoperative performance of the LiMAx test can augment surgical strategy and timing of surgery after previous chemotherapy, thus avoiding increased postoperative morbidity.