An evaluation model of hepatic steatosis based on CT value and serum uric acid / HDL cholesterol ratio can be used to predict intrahepatic recurrence of CRLM

Abstract

Abstract Background Intrahepatic recurrence is one of the main causes of treatment failure in patients with colorectal cancer liver metastasis (CRLM). Hepatic steatosis was reported to provide fertile soil for metastasis. The effect of irinotecan-inducted hepatic steatosis on the progression of liver metastasis remains to be verified. Therefore, we aim to clarify the effect of hepatic steatosis on postoperative intrahepatic recurrence in CRLM and whether it is relevant to irinotecan-based preoperative chemotherapy. Methods Data for a total of 284 patients undergoing curative surgical treatment for CRLMs were retrospectively reviewed between March 2007 to June 2018. Hepatic steatosis score (HSS) was established by combining Liver to Spleen CT ratio (LSR) and Uric acid to HDL-cholesterol ratio (UHR) to detect the presence of hepatic steatosis. Results The evaluation model is consistent with pathological results and has high prediction ability and clinical application value. Patients with HSS high risk (HSS-HR) had significantly worse prognosis than those with HSS low risk(HSS-LR) (RFS: 42.7% vs. 29.4%, P = 0.003; OS: 45.7% vs. 26.5%, P = 0.002). Univariate and multivariate analysis confirmed its essential role in the prediction of intrahepatic RFS. Besides, HSS model could distinguish high risk patients better among those treated with irinotecan-based chemotherapy. Furthermore, patients treated with preoperative irinotecan chemotherapy were more likely to end up with HSS-HR than those with non-irinotecan chemotherapy (63.3% vs. 21.8%, P<0.001). Conclusion In summary, patients with HSS-HR had significantly worse OS and intrahepatic RFS. HSS-HR may be relevant to Irinotecan chemotherapy and had distinctly poor prognoses in patients with irinotecan-based chemotherapy.