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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2021

01-04-2021 | Scintigraphy | Hepatobiliary Tumors

The Impact of Modern Chemotherapy and Chemotherapy-Associated Liver Injuries (CALI) on Liver Function: Value of 99mTc-Labelled-Mebrofenin SPECT-Hepatobiliary Scintigraphy

Authors: Stéphanie Truant, MD, PhD, Clio Baillet, MD, Viviane Gnemmi, MD, PhD, Maxence Fulbert, MD, Anthony Turpin, MD, PhD, Sabrina Dardenne, MD, Emmanuelle Leteurtre, MD, PhD, Mehdi El Amrani, MD, PhD, Sébastien Dharancy, MD, PhD, Laurent Dubuquoy, PhD, Damien Huglo, MD, PhD, Christophe Chesné, PhD, François-René Pruvot, MD, PhD

Published in: Annals of Surgical Oncology | Issue 4/2021

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Abstract

Background

Chemotherapy is increasingly used before hepatic resection, with controversial impact regarding liver function. This study aimed to assess the capacity of 99mTc-labelled-mebrofenin SPECT-hepatobiliary scintigraphy (HBS) to predict liver dysfunction due to chemotherapy and/or chemotherapeutic-associated liver injuries (CALI), such as sinusoidal obstruction syndrome (SOS) and nonalcoholic steatohepatitis (NASH) activity score (NAS).

Methods

From 2011 to 2015, all consecutive noncirrhotic patients scheduled for a major hepatectomy (≥ 3 segments) gave informed consent for preoperative SPECT-HBS allowing measurements of segmental liver function. As primary endpoint, HBS results were compared between patients with versus without (1) preoperative chemotherapy (≤ 3 months); and (2) CALI, mainly steatosis, NAS (Kleiner), or SOS (Rubbia-Brandt). Secondary endpoints were (1) other factors impairing function; and (2) impact of chemotherapy, and/or CALI on hepatocyte isolation outcome via liver tissues.

Results

Among 115 patients, 55 (47.8%) received chemotherapy. Sixteen developed SOS and 35 NAS, with worse postoperative outcome. Overall, chemotherapy had no impact on liver function, except above 12 cycles. In patients with CALI, a steatosis ≥ 30% significantly compromised function, as well as NAS, especially grades 2–5. Conversely, SOS had no impact, although subjected to very low patients number with severe SOS. Other factors impairing function were diabetes, overweight/obesity, or fibrosis. Similarly, chemotherapy in 73 of 164 patients had no effect on hepatocytes isolation outcome; regarding CALI, steatosis ≥ 30% and NAS impaired the yield and/or viability of hepatocytes, but not SOS.

Conclusions

In this first large, prospective study, HBS appeared to be a valuable tool to select heavily treated patients at risk of liver dysfunction through steatosis or NAS.
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Metadata
Title
The Impact of Modern Chemotherapy and Chemotherapy-Associated Liver Injuries (CALI) on Liver Function: Value of 99mTc-Labelled-Mebrofenin SPECT-Hepatobiliary Scintigraphy
Authors
Stéphanie Truant, MD, PhD
Clio Baillet, MD
Viviane Gnemmi, MD, PhD
Maxence Fulbert, MD
Anthony Turpin, MD, PhD
Sabrina Dardenne, MD
Emmanuelle Leteurtre, MD, PhD
Mehdi El Amrani, MD, PhD
Sébastien Dharancy, MD, PhD
Laurent Dubuquoy, PhD
Damien Huglo, MD, PhD
Christophe Chesné, PhD
François-René Pruvot, MD, PhD
Publication date
01-04-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08988-4

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